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Youth Rush Application
1. First Name: *
2. Last Name: *
3. E-mail Address: *
4. Street Address: *
5. City: *
6. State / Province / Region: *
7. Zip Code: *
8. Home Phone Number:
9. Cell Phone Number:
10. Date of Birth: *
11. Marital Status: *
12. Gender:  Male;   Female;  *
13. If hired, would you be able to provide evidence of authorization to work in the U.S.?  Yes;   No;  *
14. School Currently Attending: *
15. Current Grade/Year in School:
16. Which school do you plan to attend next year?
17. How long have you been a Seventh-day Adventist? *
18. Why do you desire to canvass this summer with the Youth Rush program? *
19. What are your hobbies? *
20. What type of music do you enjoy? *
21. Do you speak Spanish?  Yes;   No;   Some;  *
22. How did you hear about Youth Rush? *
23. Would you be interested in SOULS WEST? For more information about SOULS WEST visit www.soulswest.org:  Yes;   No;   Maybe;  *
   
Pastor Information  
24. Pastor's First Name: *
25. Pastor's Last Name: *
26. Street Address:
27. City:
28. State:
29. Zip Code:
30. Pastor's Phone: *
   
Reference (non-relative) Information  
31. REFERENCE (non-relative) First Name: *
32. REFERENCE (non-relative) Last Name: *
33. Street Address:
34. City:
35. State:
36. Zip Code:
37. REFERENCE (non-relative) Phone: *
   
Parent/Guardian Information  
38. Parent/Guardian First Name: *
39. Parent/Guardian Last Name: *
40. Additional Parent/Guardian First Name: *
41. Additional Parent/Guardian Last Name: *
42. E-mail:
43. Street Address:
44. City:
45. State:
46. Zip Code:
47. Parent/Guardian Phone:
   
48. Have you ever been disciplined for actions which violate Seventh-day Adventist standards/principles, or for anything illegal? If yes, please explain. *
   
49. By checking this box, I understand that the employer will thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. I authorize all individuals, schools, and firms named therei:  Yes;  *
50. Any comments?

Fields marked with an * are required.

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