J-1 Work Travel Application


Please complete this form and click the submit button at the bottom of the page. 

Required fields are highlighted in red.                       

PERSONAL INFORMATION

Surname  
First Name  
Street Address  
Address (cont.)  
City  
State/Province  
Zip/Postal Code  
Country  
Cell Phone  
Home Phone  
Parents Phone  
E-mail  
Passport No.  
 Driver License No.  

 

PLEASE DESCRIBE YOURSELF

Non disclosure of any medical / criminal history will result in cancellation from the program and forfeiture of all payments made to Signature Services.  All participants are required to be in good physical and mental health.

Birth Date   -- mm/dd/yy Age  
Gender   Male Female    
Height   Weight  
Are you married?   Yes No
If yes, is your
spouse applying?
  Yes No
Do you smoke?   Yes No
Do you have any
visible body tattoos
and/or/piercings?
  Yes No
Do you have any
dietary restrictions?   
  Yes No
Do you have
any health problems?
  Yes  No

Are you presently
on any medications?

  Yes No Do you have any
physical disabilities?
  Yes  No
Have you ever suffered
from a nervous breakdown,
depression, or a mental
disorder?
  Yes  No
Have you ever had an
eating disorder
(ex. anorexia)?
  Yes No
Have you ever been
 convicted for any offense
or crime?
  Yes No
Are you currently
 subject to a police
 investigation?
  Yes No
Have you ever been
 charged with a criminal
offense?
  Yes No
If you have been charged
or convicted of a criminal
offense, please supply
details:
 
Have you ever been
a victim of sexual abuse?
  Yes No

Have you ever been
a victim of physical abuse?

 

  Yes  No
   

If you have been a
victim of physical
or sexual abuse,
please supply details:

 

 

What is your earliest date of departure?   - mm/dd/yy What date are you due home?   - mm/dd/yy
Are you a student?   Yes No
Course / Subject?
Are you employed full-time?   Yes No
Occupation?  
Do you have experience in an international cultural exchange program? Yes  No
What position?  
Do you have experience with American summer camps? Yes   No
Describe experience:  
Will you work in a camp with religious emphasis? Yes  No
 
Do you have a personal religious commitment?   Yes No    
Are you willing to participate in bible studies and devotions? Yes  No
   
Do you attend church services regularly? Yes  No
If so, what church?  
Do you have experience pioneering, scouting, or in guides? Yes  No
Please describe pioneering, scouting, or guiding experience:  
Have you ever been away from home for an extended period of time? Yes  No

Describe your experience away from home:

 

SKILLS - please check all that apply:

  Willing Experienced
Cooking
Dining Hall Service
Dining Hall Manager
Dishwashing
Food Preparation
Assistant Cook
Baking

 

Please describe fully the skills you have detailed on this application. Describe your work experience - positions held, length of time, duties and responsibility:  
What qualities do you possess that will make you and excellent candidate for a position with Signature Services?  
What experience do you have that demonstrates your ability to work long hours and to live in a community with strict rules (i.e. no smoking, no drinking)?  
Give examples of your ability to adapt to new and different situations.  
If English is not your first language, how confident are you in your ability to work effectively using the English language and why?  
How well do you work as a member of a team? Give an example.  

 

EMERGENCY INFORMATION

Doctor's Name  
Doctor's Phone #  
Emergency contact (friend or family):  
Emergency Contact Address:  
Emergency Contact Phone #  

 

AGREEMENT

The facts set fourth in my application for employment are true and complete.  I understand that if employed, any false statements on this application may result in my dismissal.  I further understand that this application is not and is not intended to be a contract of employment, nor does this application obligate the employer in any way if the employer decides to employ me. 

 

I Agree (name of applicant):

 

If you have form errors, you will be presented with an errors page.  Click the back button on your browser and correct your errors then submit again.


Copyright 2003 [Signature Services Corporation]. All rights reserved.
Revised: 12/10/08