Mentor Application Through life and career skills, CJC offers men and women the opportunity to reach their full potential. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Complete application form in its entirety. For questions please contact cjcdirector@cwjc.net. If you prefer you may download and print the application form. Please email completed forms to cjcdirector@cwjc.net or mail to: Christian Job Corps P.O. Box 525 Huntsville, AL 35804 Applicant InformationApplicant Name *FirstLastLayoutCell Phone Number *Email *Home Phone NumberBirth Date *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmploymentLayoutEmployer *Position Held *EducationLayout (copy)Education Completed *Special Training *Church MembershipLayoutName of Church *Pastor's Name *Emergency Contact InformationLayoutName *Cell Phone Number *Relationship to you *Home Phone Number *ReferencesPlease list three personal references.LayoutName *Relationship *Phone Number *Email *Name *Relationship *Phone Number *Email *Name *Relationship *Phone Number *Email *Tell Us About YourselfTell us about any church or community activities you are involved in.LayoutChurch or Community ActivityCurrent?Current ParticipationPrevious ParticipationLayoutChurch or Community ActivityCurrent?Current ParticipationPrevious ParticipationLayoutChurch or Community ActivityCurrent?Current ParticipationPrevious ParticipationLayoutChurch or Community ActivityCurrent?Current ParticipationPrevious ParticipationAdditional InformationHow did you hear about Christian Job Corps? *Why do you want to serve as a Christian Job Corps mentor? *What spiritual gifts, skills, abilities, talents, traits, experiences, etc., do you bring to the mentoring relationship? *Have you accepted Jesus Christ as your personal Lord and Savior? Please tell us about that experience. *Will you commit to attend a Mentor Training session? *YesNoDo you give your permission for a background check to be run on you? *YesNoSubmit Application
