Application Form for Co-Workers

Name:

Date of Birth:

Marital Status:       Single     Married     Divorced     Widowed

Do you have Children? If yes, how many, what ages?

Nationality:

Current Address:

E-mail Address:

How did you hear about Friends of Camphill India?

Have you applied to any other Residential Community? If yes, where and when?

Have you worked in / visited a Residential community? If yes, where and when? Who was your Contact Person there?

Do you have any Health / Psychological Problems, past or present?

Do you take Medication? If yes, which and for what?

Do you have any Allergies? If yes, please give Details.

Have you had any Experience with Drugs? Did they or do they still play any Significant Part in your Life?

Education:   School:

                  College:

                 Degrees:

Work Experience up to and including present employment:

Hobbies, Special Interest / Experience in any Craft, Art, Music, etc.:

Have you had any experience working with people who have mental disabilities?

What is the approximate date when you would like to join us? For what period of time?

Along with this application form please furnish us with the following.

1.        Your Educational Certificates.

2.        Certificates relating to your Work Experience.

3.       Two Letters of Recommendation from Teachers/Professors and/or an Employer. These should come from someone in a Responsible Position who knows you well and is not related to you.

4.        Two recent Passport Photos

5.        A Write-up about yourself in your own Handwriting and in Narrative Form. Include your Motives for wanting to join a Community with Mentally Disabled Adults.

I hereby declare that all the information provided in this application is factual and true.

Place / Date                                                                                                Signature