The Application Form

If you would like to apply, please complete the following form:

Application Form - Impact Training

*(denotes required field)

Name: *

E-Mail Address: *

General Information

Select

Spring 2012
Fall 2012
Spring 2013

Gender

Date of birth

Marital status

Telephone (inc country and area code)

Address

Emergency Contact

Emergency contact name

Emergency contact e-mail

Emergency contact telephone no.

Relationship to applicant

Personal Profile

Level of training completed

Work experience

Skills / interests / hobbies / sport involvements

Temperament tendencies

Introverted / extroverted

1 - Introverted
2
3
4
5 - Extroverted

People oriented / task oriented

1 - People oriented
2
3
4
5 - Task oriented

Which best describes you?

Takes charge and get things done
Easy going ready to assist others
Likes details wants to consider all options first
Enjoys lots of people around

How would others characterize you?

Do you prefer to work alone or with others?

Do you live with your family?

Before leaving home in the morning would you have made your bed and tidied your room?

Are you actively involved in your local church? How?

Are you born again of the Spirit of God? How do you know this?

How would you describe your Christian walk?

Please give a comprehensive explanation of why you want to participate in our program and what you believe may be your contribution to the team and in what areas you would like others to help you.

Health

Do you suffer from any disability that would limit you doing practical duties?

Have you had a nervous or mental illness at any time?

Have you suffered from and had treatment for anorexia nervosa or bulimia?

Do you suffer from any allergies?

Do you have diabetes, epilepsy, blackouts or other medical problems?

Do you require any regular prescribed medication?

Do you require a special diet for medical reasons?

Do you require a vegetarian diet?

Do you have a learning disability?

Have you used alcohol, tobacco or illicit drugs (incl. marijuana) in the last year?

Have you ever had treatment for alcoholism or drug addictions?

Have you anything in your past that could influence your time here e.g. prison sentence, divorce?

If you answered yes to any of these health questions, please provide full details here

Conditions of Enrolment

In applying for this program you pledge to apply yourself wholeheartedly:

To crew the ship, assisting in sailing, mooring, domestic & maintenance work
To participate in all aspects of the training program, including the satisfactory completion of assignments and participation in outreaches
To attend the whole course from beginning to end. No refunds will be given for early departure
To dress modestly, and generally be clean and tidy responding positively to directives of the leadership team as relates to appropriate conduct in our environment and culture
To abstain from smoking & consuming alcohol whilst aboard
To financially compensate for any damages caused to property or persons that you may have caused
To fully comply with any directives given by the skipper and leadership team

We reserve the right to terminate the participation of any person who does not satisfactorily comply and the balance of the fees will be forfeited.