Please attach a recent photograph here.

confidential

Application for Bahá’í Youth Year of Service

Surname____________________________________________________________ rMale rFemale

Given Names______________________________________________ rDr rMr rMrs rMs rMiss

Street Address______________________________________________________________________

Town____________________________________ State_____________________________________

Post Code______________ Country_____________________________ E-Mail______________________________________

Phone (H)______________________________ (W)_____________________________ Fax___________________________

Date of Birth ( / / ) Place of Birth___________________________________________________________

Citizenship_________________________________________ Ethnic Background___________________________________

Passport Number______________________ Issuing Office________________________ Expiration Date ( / / )

Languages (circle appropriate rating for each) Speaking Proficiency Reading Proficiency Writing Proficiency

___________________________________ 0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5

___________________________________ 0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5

___________________________________ 0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5

Do you hold a valid international driver’s licence? rNo rYes (specify country)____________ Expiration Date ( dd / mm / yyyy )

Marital Status rSingle rWidowed rSeparated rDivorced rMarried If married, is your spouse a Bahá’í? rYes rNo

Will family members be accompanying you? rNo rYes (please describe arrangements)___________________________________

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Please list education starting with high school, including trade or correspondence courses and apprenticeship programmes.

Name, location of Institution

Years Attended

Degree Received

Major Subjects

Please list employment, in reverse order, for the last four years, including volunteer work, apprenticeships, temporary or summer jobs, etc. You may attach additional sheets or a résumé / curriculum vitae.

Dates of Employment	Name of Employer	Employer E-mail or Phone Number	Title / Position	Nature of Work & Responsibilities	Reason for Leaving
	Current Employer	Mailing Address

May we contact your employers for a reference? rYes rNo

Date of Bahá’í Registration ( dd / mm / yyyy ) Bahá’í Identification Number (if applicable)____________________________

Community in which you registered____________________________ Present Bahá’í Community__________________________

Describe your experience as a Bahá’í, including community life, committees and Assemblies you served on, and pioneering or travel-teaching service. Include dates.

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List Ruhi courses or any other training institute courses you have completed. Indicate if you are certified as a facilitator of any of such courses.

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List any other special qualifications or talents that can be of use to the Bahá’í Community.

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When can you begin? ( dd / mm / yyyy ) How long can you serve?____________________________________________

What types of service are you prepared and willing to do? (check all that apply)

rTravel Teaching rHolding Firesides / Deepenings rTeaching Children’s Classes rDesigning Web Sites

rSecretarial Work rCleaning rDance Workshop and other Performing Arts rGardening

rGuiding / Security

rOther (please specify)__________________________________________________________________________________

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Do you have sufficient funds for travelling and living expenses? rYes rNo

If no, explain in detail how you plan to finance your Service Period. (Note: Financial and other support from the Baha’i Community in Japan differ depending on each project; so contact the Youth Desk for specific information.

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Living in a foreign culture can be very challenging. Please explain how you would prepare yourself to service in Japan.

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I, (please print full name clearly) ________________________________________ , hereby declare that I am a Bahá’í in good standing, and that I intend to undertake a Bahá’í Youth Service. I declare that I have presented all information thoroughly, honestly, and accurately.

Signature__________________________________________ Date______________________________________________