Part-Time Counseling Center Administrator
Please complete the Application Form and hit submit once completed.
Date
*
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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Are you a citizen of the United States?
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Yes
No
If no, are you authorized to work in the U.S.?
Please select one option.
Yes
No
Have you ever been convicted of a felony?
*
Please select one option.
Yes
No
If yes, explain:
Do you consider yourself a Christian?
*
Please select one option.
Yes
No
Do you belong to a Small Group?
*
Please select one option.
Yes
No
Are you a church member or currently pursing membership at Jacob's Well Church?
*
Please select one option.
Yes
No
Would you consider yourself more:
*
Please select one option.
Task oriented
People oriented
Education
Name of High School
*
Number of Years Completed
*
Name of College
Number of Years Completed
Major & Degree
Work Experience
Company Name #1
Address
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FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
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Job Start Date
Job End Date
Position
Reason for Leaving
May we contact this employer?
Please select one option.
Yes
No
Company Name #2
Address
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GA
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HI
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LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
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SC
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Job Start Date
Job End Date
Position
Reason for Leaving
May we contact this employer?
Please select one option.
Yes
No
Skills
Please check all of the areas you have experience in:
*
Please select all that apply.
Microsoft Word
Microsoft Excel
Google Workspace
Theranest
What is the Gospel?
*
What are your thoughts on the relationship between counseling and the church?
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What are your thoughts on counseling in general?
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What excites you most about the job description?
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What part of the job would be more unfamiliar or difficult for you?
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What is your willingness to learn and implement new programs and practices for the Counseling Center?
*
Please list any relevant administrative experience (if any):
Please share additional skills and/or experiences that you have that would help you qualify for this position:
Date you could begin
*
Questions for us?
References (please list two)
Reference #1 Name
*
Company
Relationship
*
Address
*
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GA
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IL
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LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
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VI
VT
WA
WI
WV
WY
YT
Phone
*
Reference #2 Name
*
Company
Relationship
*
Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Phone
*
Submit
Description
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