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Directions for Internship Application
❑ Complete the entire application
❑ Update your resume and attach
❑ Email completed application, resume, and a photo of yourself to
or mail to:
Genesis Church
Attn: Internships
P.O. Box 801
West Plains, MO 65775
Applications are received and Interns are accepted without regard to race, creed, color, sex, age, national origin, marital status, physical or mental handicap, veterans status and citizenship status. The receipt of this application does not mean that an Intern position is available nor does it obligate us in any way. We appreciate your interest in our organization. Please submit this completed application along with a resume. While completing this application if you find it necessary to provide additional comments or explanations to questions asked, please include. PLEASE PRINT OR TYPE ALL INFORMATION!
Date Prepared ______________
Personal Information
Name _____________________________________________________________________________________________ First Middle Last
Address _____________________________________________________________________________________________Street City State Zip Code
Home Phone ___________________________ Cell Phone ______________________________ Email ____________________________________ Gender (M) (F) Age _______ Date of Birth ______________________ Birthplace (City, State) ________________________
Marital Status (Y) (N) (Divorced)If Married, Spouse’s Name and date of Marriage __________________________________________Name and Ages of Children (If Applicable) __________________________________________________________________________________________________________________________________________________________________________________________
Are you a citizen of the United States? (Y) (N) What languages can you read, speak and write fluently? _______________________________________Emergency Contact Name _______________________________ Relationship _____________________ Phone _____________________ Email ____________________________________Have you ever been convicted of any crime other than a minor traffic violation? (Y) (N)If yes, please explain. ____________________________________________________________________________________________________________________________________________________________________
Have you ever applied for a job or internship or been employed by Genesis Church? (Y) (N)If yes, list position. __________________________________________________________________________
Church Affiliation
Name of home church _______________________________ Denomination _______________________Location (City, State) _________________________________ Phone Number ______________________How long have you been a member of this church? ______________ Name of Senior/Lead Pastor _________________________________________________________________
In what capacity are you currently volunteering? ___________________________________________________________________________________________________________________________________________
Name of person you currently serve under? ___________________________________________________
Briefly explain when and how you became a Christ Follower? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________
Internship Information
Internship requested in the following ministry areas? _________________________________________
Reason for this choice? ___________________________________________________________________________________________________________________________________________________________________
If an internship is not available for the ministry area you prefer, what other areas are of interest to you? __________________________________________________________________________________________________________________________________________________________________________________
Education Information
Name of High School attended _______________________________________________________________Graduation Date _____________________ Location (City, State)__________________________________
List colleges, universities, or other schools you have attended:
Name ________________________________________ Location (City, State) ______________________
Dates Attended ________________________________ Diploma / Degree ___________________
Name ________________________________________ Location (City, State) ______________________Dates Attended ________________________________ Diploma / Degree ___________________
Name ________________________________________ Location (City, State) ______________________Dates Attended ________________________________ Diploma / Degree ___________________
Employment Information
Current Employer ____________________________________ Current Position _____________________Date Hired ____________________ Responsibilities ______________________________________________Name of Immediate Supervisor ___________________________ Phone Number ____________________
Previous Employer ___________________________________ Position _____________________________Dates of Employment ______________ Responsibilities _________________________________________Name of Immediate Supervisor ___________________________ Phone Number ____________________
Previous Employer ___________________________________ Position _____________________________Dates of Employment ______________ Responsibilities _________________________________________Name of Immediate Supervisor ___________________________ Phone Number ____________________
Personal References
Name _____________________________________________ Phone Number _____________________ Years Known _______ Relationship______________________________
Name _____________________________________________ Phone Number _____________________ Years Known _______ Relationship______________________________
Name _____________________________________________ Phone Number _____________________ Years Known _______ Relationship______________________________
Applicants Statement - Read Carefully
The information I have given is correct and may be verified by Genesis Church if necessary. I understand that if I am admitted to the Genesis Leadership Experience, Genesis Church reserves the right to disqualify me from the Internship Program for any reason it deems appropriate. I hereby release and hold Genesis Church harmless from all claims arising under this application. I further understand that a criminal record check may be conducted on me and I consent to any such check.
____________________________________________________________________ ___________________Signature Date