DATE _________________________________  

Circle Position of Interest: 

       Counselor   Nurse    Boutique   Clerical    Housekeeping   Babysitter 

List the hours you can work during these hours that we are open  

      Mon. 5 – 7 pm              Wed. 1- 7 pm              Fri. 1 – 7 pm 

   Mon: __________         Wed: __________          Fri: __________

 

  Name ________________________________________________________

 

Phone (day)  Phone (evening)

(________)______________________          (_______)____________________

 

Address_____________________________________________________________

 

 City _______________________________________ Zip Code _______________

  

Date of Birth _____/_____/_______    Age_______   Circle:  Married    Single 

 

If Married, spouse’s name______________________________________________

  

Training/Gifts: 

1.     1.  Special gifts, talents or personality traits you can bring to this ministry?

 

 

 

 

 

 2.  Educational Background?  List any special training, Biblical Studies or educational experience.

 

 

 

 

 

 

 

      3.    Describe 5 things you have enjoyed doing most in your life from age five until now.  Describe what you did well and what made you enjoy doing it.  Describe each experience in a few sentences.

 

 

 

 

 

 

 

 

 

 

 4.    What are your areas of strength?

 

 

 

 

      5.    What are your areas of weakness?

 

 

 

      6.    What personality do you have difficulty working with?

 

 

 

 7.    How do you resolve conflict/disagreements?

 

 

 

GENERAL INFORMATION: 

     1.    What is your reason for getting involved in the APCC?

 

 

     2.    How did you hear about the Apopka Pregnancy Center?

 

 

     3.    What other ministries or organizations have you either been a lay Counselor for or been involved?

 

 

 

 

     4.    How does your spouse/family feel about this involvement?

 

 

     5.    Have you ever counseled a woman who was considering an abortion?   Yes        No

 

     6.    Have you ever known a single mother?     Yes             No

 

     7.    Under what circumstances, if any, would you consider abortion as an alternative for women’s crisis pregnancy?

 

 

 

 

 

 

 

 

 

 

 

     8.   What is your knowledge of:

         a) abortion risks? 

 

           ____Excellent         ____Good          ____Fair       _____ Poor

     

     b)  existing laws regulating abortions? 

 

          _____Excellent        _____Good       _____Fair       ______ Poor

 

      9.    Please list any books, films or other materials that you have read or viewed that relate to abortions.

 

 

 

 

 

     10. How do you feel about a single woman parenting her baby?

 

 

     11. How do you feel about a woman placing her baby for adoption?

 

 

      12. Are you currently seeking to adopt a child?    Yes    No

 

13. When do you think sexual intercourse is morally permissible?

 

 

     14. What are your feelings regarding birth control and teenagers or adults who are sexually active?  

         

     15. If selected as a counselor, will you consistently make a commitment each week to God's work through APCC?  

                                                Yes         No  

Please list any further comments that might be helpful for the Director to know you better.

 

 

 

 

 

 

 

SPIRITUAL WALK:

 

1.    Do you consider yourself a Christian?             Yes                  No

 

If yes:

a.   please explain what it means to be a Christian:

 

 

 

 

 

b.   How long have you been a believer? __________

 

c.   Please give a brief testimony about you came to believe in Jesus Christ/ Messiah as your personal Lord and Savior.

 

 

 

 

 

d.   How has your life changed since your personal relationship with the Lord began?

 

 

 

 

 

e.   What church do you attend? ___________________________________________________

 

 

Address_________________________________ City______________  State ________  ZC­­­ ____________

 

Phone Number_____________________________   Pastor _________________________

 

Are you a member?   Yes             No 

f.      How long have you been involved at your church?   ___________

 

g.    Are you currently involved in a Bible Study?    Yes         No

 

If yes, how long? _____________  

 

 

 

2.    Do you have a daily devotional time?       Yes      No

 

If yes, briefly describe:

 

 

 

 

3.    Volunteering at the APCC is spiritual warfare.  How do you feel you will personally handle this?   Briefly describe?

 

 

 

 

 

 

References:

 

Please list the names and addresses of two other people we may contact for references:

 

 

 

 

 

 

 

MISSION STATEMENT

 

 

Under the Lordship of Jesus Christ, the mission of the Apopka Pregnancy Center is to support and care for those affected by an unplanned pregnancy.  This will be accomplished by helping families make life affirming choices through evangelism, instruction and mentoring.

 

 

 

 

 

 

 

 

 

OFFICE USE ONLY

Date Returned ______________________________

 

 

 

Interview Date ___________________________      Interviewed by______________________________

 

 

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Director’s Approval   ______________________________________________________

 

 

Date _____________________________