We highly recommend answering the longer questions in Word or a similar program and cutting and pasting so you don't accidentally lose a lot of work. You cannot save this form and return to it. You can also view this application in pdf.

All information in this application will be kept confidential. If you have any questions or additional info, please send it in an e-mail to jedbenoit@gmail.com. Couples please fill out 2 forms. (for overlapping info you can use "see spouse")

General Information

Full Name
Nickname
**Attach a digital photo of yourself (please crop others out if needed)
**Supported file types: jpg, gif, tif, png, bmp, raw. Please attach a file smaller than 1MB, or your form may not go through.
Permanent Address
City
State/Province
Zip/Postal Code
Country
Temporary Address (if different than above)
City
State/Province
Zip/Postal Code
Country
Telephone (w/ country/city code)
Fax (w/ country/city code)
E-mail Address
Birth Date (MM/DD/YYYYY)
Age
Gender	M F
Nationality
Citizenship
Passport Number
Passport Expiration
Marital Status	Single Married Engaged Widowed Divorced Separated Remarried

If divorced, separated or remarried please give the relevant history.


Spouse Information

Spouse Full Name
Spouse Nickname
Spouse Birth Date (MM/DD/YYYY)
Spouse Age
Spouse Gender	M F
Spouse Nationality
Spouse Citizenship
Spouse Passport Number
Spouse Passport Expiration
What is your anniversary?
Children's Names, Age, Gender	M F
	M F
	M F
	M F

Emergency Contact Information

Contact Name
Relation to You
Home Phone (with country and city code)
Work/Cell Phone (with country and city code)
E-mail Address

Areas of Ministry Interest

In which of the following areas of ministry are you primarily interested? If you haven't looked at the ministry positions, please take a minute to look those over.

Pastoral
Leadership
Musician instrument


Missions Experience, Education, and Abilities

How many short-term mission trips have you been on?

What groups or organizations have you worked with?


Education (Schools attended and Degrees earned)


List your talents, abilities, and gifts that can be useful in the ministry


List your weaknesses and the areas in which you need to grow


Are you an ordained or licensed minister?


What ministries have you been involved in within your church?


What languages do you speak? (Language and Proficiency 1-10)  
 
 

References

It is our policy to contact your references directly, introducing ourselves as a ministry in Cusco, Peru with Commission to Every Nation and asking for their counsel and input regarding your application. We ask that you have your pastor complete and return directly to us one reference form, and that you have another spiritual leader who knows you well submit the other form to us.

Does your pastor know that you are sending us this application?

How does your pastor feel about your desire to work in missions?


Pastor's Name


Name of your church


Denomination


Your Pastor's Telephone Number (with country/city code)


Your Pastor's E-mail Address


Your Missionary Support

Finances

Each missionary is required to raise their own support for housing, food, etc. here in Cusco plus contribute $50/ month (only $50 for a couple as well) towards a ministry fund used for renting facilities, materials, outreach, etc.

Do you understand that you are completely responsible for your finances while serving here?

Prayer Support

Upon entering the mission field, you will be fully immersed in spiritual warfare. It is essential that you have people who are covering you in prayer. We suggest that you have a minimum of 20 prayer partners who have committed themselves to intercede and pray for you, for your ministry, and for the people to whom God sends you. Start now to form your team of prayer partners. Make a list of their names and addresses, so that you can keep them informed of your ministry is Cusco.

Christian Life and Calling

Describe your conversion experience and present relationship with the Lord.


How do you know that God has called you to this ministry in Cusco?


Describe in detail your prior experiences serving as a missionary and/or in your church.


What are your long-term goals (2 years, 5 years)?


Personal Application

Have you ever had or do you currently have problems in any of the following areas? Mark them with a check and give a detailed description below.

Lawsuits of any nature
Civil or military violations
Experiences with the occult
Use of illegal drugs and/or alcohol
Fornication (pre-marital sex)
Eating Disorder
Homosexuality
Pornography
Financial Debt
Stealing
Psychological Problems/Depression

Details:


Describe your reputation; how do you think others see you?


How do you respond when things don't work out as you had planned?


How do you respond to the correction of others in your areas of weakness or when you make a mistake?


How do you respond in a situation of conflict between you and another person?


Please number yourself from 1-10 depending on where you see yourself in the following spectrum (1 being extreme to the left description and 10 being extreme to the right description).

Compulsion to work Slow to put out effort
Challenge authorities Very submissive
Focus on needs of others Focus on own needs
Extroverted Introverted
Firm and consistent Flexible
Private Open
Very Emotional Very Controlled

Health Information

To the best of your knowledge, have you or your dependents been or are currently being treated for (check Y or N):

Y  N — Condition of the brain or nervous system including epilepsy, fainting, frequent or severe dizziness?

Y  N —  Any nervous, mental or emotional disorder?

Y  N —  The respiratory system including tuberculosis, asthma, severe hay fever, pleurisy, adenoids, tonsils?

Y  N —  Condition of the heart or blood vessels including abnormal blood pressure, anemia?

Y  N —  The gastrointestinal tract, liver or pancreas including gallstones, ulcers, hernia, rectal trouble?

Y  N —  The genitourinary organs including kidney trouble, prostatitis, albumin in the urine?

Y  N —  Cancer, rheumatism, bursitis, arthritis, disorder of the back, varicose veins?

Y  N —  Endocrine system including sugar in the urine, diabetes, thyroid, adrenal disorder?

Y  N —  Any physical deformity or defect including Acquired Immune Deficiency Syndrome (AIDS)?

Y  N —  Pregnancy? If yes, estimated delivery date:

Y  N —  Do you use or have you used tobacco, alcoholic beverages, marijuana or other drugs such as narcotics, stimulants, depressants or psychometrics?

Please give a detailed explanation


Y  N —  During the past 5 years have you or your dependents had medical consultation, been hospitalized or are you currently taking medication? If yes, list below:

Record of Consultation

Please list names, injury or illness, date(s), and degree of recovery:


Family Doctor

Name
Address
Phone Number (with country/ city code)
Fax Number (with country/ city code)

How did you hear about the Benoit's ministry in Cusco?

Friend
Name of Friend (optional):
Through a church or other ministry
Another Website
Name of Website:
Other
Describe:

Statement of Cooperation

1. I have read the Statement of Faith (will open in new window) pertaining to the ministry in Cusco.  I am in agreement with it and live according to these tenets of faith.

2. I have read the Policies and Contemporary Issues (will open in new window) and am in agreement with them.

3. I understand Commission To Every Nation (of which we are a part) is built upon the concept of family and is a cooperative effort of brothers and sisters in the body of Christ working together to serve our Lord.  I will do my part to foster a harmonious environment of love and respect among the team.

4. I will do my part to foster communication by regularly staying in touch with Commission To Every Nation through my Monthly Ministry Report and sharing appropriate needs and testimonies. (Only applicable if you are a CTEN missionary).

5. I understand that ministry support from the United States will be handled through CTEN.  (Only applicable if you are a CTEN missionary). Otherwise I will not be able to use the ECFA logo identifying all our funds are accountable and auditable by ECFA standards.

Electronic Signature (Your Name)