APPLICATION FORM

Welcome to the Application Process!Thank you for your interest in the Solid Ground Programme. If you believe that you have what it takes to be a Solid Ground Intern at Rocklands Centre, you are invited to take the next step and complete this application form. You may either download the fillable PDF application form and email it back to us on completion, or you may print it out and complete it by hand. If you choose to send us a handwritten copy, please ensure that you write legibly and that you have scanned the document correctly before emailing it back to us. If you have any questions, please email us at info@rocklandscentre.co.za. Please contact us if you don't hear back from us within 2 weeks. The application form covers the following areas:

1. Personal Information (Contact details & current circumstances)2. Testimony of Faith (Spiritual life & beliefs)3. Personal Insights (Strengths & interests)4. References (Character references)5. Health (Physical & emotional well-being)6. Expectations (Participant agreement - Read this first!)

PLEASE BE SURE TO COMPLETE ALL FIELDS. Mark with N/A if not applicable. If you are completing the fillable PDF, you may type your name or insert a digital signature at this stage. If you are invited for an interview, we will ask you to bring a signed original of the expectations page. The form may take a while to complete, so grab a cup of coffee, find a comfy chair, and go for it! We look forward to getting to know more about you.

One in Christ,

Simon Krige(On Behalf of Rocklands Centre)

PERSONAL INFORMATION

First Names*

Surname / Last Name*

Preferred Name (if different)

Date of Birth* (dd/mm/yyyy)

ID or Passport Number*

Gender* Male Female

Attach an ID or Passport Photo

here or as a separate data file:

CONTACT INFORMATION

Email 2Email*

Facebook Link

Phone Number*

Residential Address*

Phone 2

(Street Address)

(Street Address line 2)

(Suburb)

(City)

(Province / State)

(Country)

(Postal Code)

PERSONAL INFORMATION

Do you have a driver's license?* (It must be valid in South Africa)

Yes. Pass Date (dd/mm/yyyy) No.I have my learner's licenseI have a driver's license that is NOT valid in S.A.

DRIVER'S LICENSE

Married Engaged Dating Separated Divorced

(Please note that due to the nature and expectations of the Solid Ground programme, preference will be given to young adults without dependants. We are therefore unlikely to accept your application if you answered "Yes" to this question. However, please describe your circumstances and we will prayerfully consider your application. If you have children, please indicate their names and ages.)

Do you have any financial debt?* If so, please describe how this impacts you.

What is your relationship status?*

Even if single, please describe your relationship status in greater detail.* (If single, have you recently ended a relationship or ever been in a serious relationship?)

Tell us about your family in a few words.*

Yes No Are they supportive of your application to Solid Ground?*

Do you have dependants?*

ADDITIONAL INFORMATION

How did you hear about the internship programme?*

Single

If you are to serve on the Solid Ground Internship team at Rocklands, it is essential that we know what you believe about God and Scripture, and how you walk out your Christian faith.

Please answer the following questions mtsjxyq~ (from the perspective of personal conviction..

TESTIMONY OF FAITH

Describe how you became a Christian, and include any key moments in your life that have impacted your faith.*

Briefly describe what you believe about God.*

Tell us what you believe about the Bible.*

Which Church do you attend and how long have you been attending?*

Describe ways you have served at Church or within your community.* Be sure to include any experience you may have had working on camps or with youth and children.

Describe your involvement within the life of your Church.*

Do you have any other ministry or leadership experience?* If so, please describe this to us.

Have you ever been addicted to any kind of substance or pattern of behaviour that we should be aware of? If so, please explain.*

In a few words, describe your present walk with God*

How would you like to grow spiritually during 2019?*

Do you sense God leading your life in any particular direction?*

Please feel free to share anything else which will help us know you better.

Tell us about your employment history and work experience.*

1) Where you were employedWhen you worked there

What you didWhy you left

2) Where you were employedWhen you worked there

What you didWhy you left

It is generally a requirement that you need to have completed High School or the equivalent before entering Solid Ground. Please tell us about your education.*

Name of High School / Institution*Year of matriculation or final examinations*

Tick all that apply.*

I passed my final examsI did not pass my final examsI passed with university exemptionI am currently finishing my final year and expect to passI am currently finishing my final year but am unsure whether I will passI am currently finishing my final year and expect to pass with university exemption

EDUCATION

WORK EXPERIENCE

PERSONAL INSIGHTS

Help us get to know you by honestly sharing about your experience, character, strengths, skills & interests.

Subjects taken at school.*

Subjects most enjoyed.*

CHARACTER, STRENGTHS & WEAKNESSES

Have you completed any post-high school degrees, diplomas, certificates, or courses?If so, please list these here.*

List 5 personal character strengths.* (Look up "Character Strengths" for examples)

List 3 personal character weaknesses.*

What do you like about working with a team? Explain.*

How do you handle conflict?*

Do you struggle with any of the following? Fear of heights, stage fright, fear of the dark, social anxiety, aggressive outbursts, rebellious tendencies towards authority, or anything else that may affect your competency?*

SKILLS

Why do you feel you will be a good fit for the Solid Ground team?*

What other options are you considering as alternatives to Solid Ground?*

What skills do you have? Are you a skilled musician, mechanic, or craftsman? Are you a talented swimmer, singer, or actress? Are you an artist or a baker? Are you a skilled writer or photographer? Make a list of any areas of talent and skill, and describe how much experience you have with each particular skill.*

What are you interested in, but perhaps less skilled or experienced in?* Perhaps you love the water, but you are not a confident swimmer, or you're very interested in cooking but haven't cooked very often.

IMPORTANT SKILLS FOR ROCKLANDS

These are some of the skills and values that are of particular importance within the daily workings of Solid Ground. If you're not skilled in these areas yet, there will

be plenty of opportunity to grow in the year!!

Computer literacy.*I really struggle with anything to do with computers or technology.I have a basic understanding of technology and easily type documents. I consider myself to have an above average level of computer literacy. I am highly computer literate and thoroughly proficient with technology.

Group communication skills.*I dislike speaking in groups, no matter how large or smallI don't mind sharing in small groupsI can speak in front of groups, but am not as confident as I'd like to beI am very confident in front of people & can clearly lead groups of any size

Please tick the most appropriate selection for each title:

Energy levels.*I am often negative and tend to bring group energy downI think I am quite a boring person with a neutral effect on groups People seem to find me positive and come alive around meI am a high energy person and find it easy to motivate people

Swimming.*I cannot swim and am afraid of waterI don't like swimming, but can hold myself up in deep waterI am a reasonable swimmer and enjoy swimmingI have spent many years doing water sports or lifeguarding & understand the sea

Reading and Writing.*I read and write very slowly, and don't enjoy eitherI am proficient at both, but enjoy neitherI enjoy reading and writingI am an avid reader and a good writer.

Self-Motivation.*I seldom use spare time beneficially and have a low level of initiativeI only use spare time effectively if someone directs me to be proactive I value spare time and try to be wise with how I spend itI maximise every moment and often wish there was more time in the day

Athleticism.*I do not like physical activity and avoid it whenever possible I engage in physical activity when needed, but don't enjoy it I enjoy physical activity, but can only handle so much The more I can move in the day, the better!

Hospitality.*I am often referred to as a cold or awkward personI don't really like being around people, but I can put on a friendly face I enjoy being around people, and am usually friendlyI love hospitality & do everything I can to ensure that people feel welcome

I detest changes to routines and schedulesI prefer to know exactly what is going on, but can handle some changeI don't really mind when the plan changes, as long as there is clear direction If anyone can handle some chaos in the day, it's me!

It's my way or the high-way!! I don't like doing things anyone else's way.I'm willing to consider other views but I'm probably the best leader in the room. I am good at listening, but can occasionally be stubborn.I enjoy teamwork, and happily follow leadership.

Adaptability.*

Team Spirit and the Ability to Follow.*

Self-Discipline.*I have a low level of self-discipline, & am seldom true to my word or convictions I am occasionally irrational or unreliable when faced with a challenge I consider myself to be fairly disciplinedI am highly reliable and self-disciplined

REFERENCES

Please give us the relevant details for the following references. We will contact them using the details you have provided, but

please do let them know that you have asked them to be a reference for you and that we will be contacting them.

Denomination*

Yes No

Yes No I don't know

Please select at least 2 of the following 3 options to serve as additional references.

1)EMPLOYER

Company*Name of contact / employer*

Is this a current employer?* Yes No

Yes No N / AIf so, are they aware that you will not be available tocontinue working in 2019 if accepted into the programme?

In your opinion, will this employer give you a favourablereference?

UnsureNoYes

Why or why not?

Contact Details of Above Mentioned Person

Full Name*

Contact Number*

Email Address*

PRIMARY REFERENCE: CHURCH

Church name*

Are you an official member of the church?*

Name of your Pastor or Spiritual Leader*

Are they supportive of this application?

Pastor / Spiritual Leader's Contact Number*

Pastor / Spiritual Leader's Contact Email*

2) LECTURER / TEACHER / COACH

Do you expect them to give you a favourable reference?*

Why or Why not?*

Name of lecturer / teacher / coach*

What subject did they teach / coach you in?*

How did you respond to their leadership?*

Why?*

3) FRIEND

Contact Details of Above Mentioned Person

Full Name*

Contact Number*

Email Address*

UnsureNoYes

What is your friend's Name?

How long have you known this person?*

How well do they know you?*

Do you expect them to give you a favourable reference?*

Why or Why not?*

Contact Details of Above Mentioned Person

Full Name*

Contact Number*

Email Address*

UnsureNoYes

HEALTH

Due to the nature of the programme, it is essential that you are generally healthy. Please help us evaluate

your current state of health.

How healthy do you consider yourself to be? Choose one of the following:*

Excellent Health (0-3 sick days leave anticipated in a year) Good

Health (3-7) sick days leave anticipated in a year)

Fair Health (7-10 sick days leave anticipated in a year)

Poor Health (more than 10 sick days leave anticipated in a year)

Rate your fitness by selecting one of the following that best describes your level:*

Excellent (I can easily run 5km in 25 minutes)

Good (I can run 5km in about 30 minutes)

Fair (I can complete 5km by jogging and walking)

Poor (I can walk about 2km at a time)

PERSONAL RATINGS

SPECIFICS

IN CASE OF EMERGENCYWho should we contact in the case of an emergency?

Relationship to you*

Email 1*

Email 2

Name*

Phone 1*

Phone 2

Please indicate the following:

Height*

Weight*

Blood Type (If Known)

MEDICAL AID / HEALTH INSURANCE

IMMUNISATION HISTORY

MEDICAL QUESTIONS

Tuberculosis

Whooping Cough

Diphtheria

Hepatitis B

Please mark the date of all known immunizations

Typhoid

Rubella

Mumps

Cholera

Polio

Hepatitis

Yellow Fever

Tetanus

Other

If so, when was the last time you had a cigarette?

Have you ever been a smoker? Yes No

Name of Medical Aid / Insurance*

Specific Plan*

Main Member and Membership Number*

(We strongly encourage you to have a medical aid or health insurance in place.)

Are you currently on any medication? Please give details if so.*

Do you have any chronic illnesses or allergies? Are you currently under a doctor or health care professional's care for any condition? If so, please explain.*

Do you have any recurring or long-lasting physical injuries, or do you have poor eye-sight or hearing, or anything else that may affect your physical performance?

Only as a social smoker

Arthritis

Asthma

Autoimmune Disorders(e.g. lupus, rheumatoid arthritis)

Bowel Disorders

Cancer

Dementia / Alzeihmers

Depression

Are there any of the following medical conditions in your family history that you are aware of? Please tick all that apply.

Mental Illness

Obesity

Osteoporosis

Skin Disorders

Strokes

Thyroid Over Active

Thyroid Under Active

Tuberculosis

Diabetes

Dystrophy

Epilepsy

Heart Attack

High Blood Pressure

High Cholesterol

Low Blood Pressure

Other

Have you ever had any of the following communicable diseases?

Pertussis

Measles (Rubeola)

Scarlet Fever

Mumps

Chickenpox

Measles (Rubella)

Tuberculosis

Other (Specify)

I am willing to complete this health form and to include all relevant information to the best of my knowledge.

My health status is confidential and therefore I am unwilling to complete this health form.

In the light of accurately understanding your health condition, and effectively being able to support you if you are accepted onto the programme, we ask that you honestly disclose the

following information. If disclosed to us, this information will remain strictly confidential. Please indicate one of the following:

Have you ever been treated for a psychological, emotional, or mental disorder (depression, anxiety, eating disorder, ADD/ADHD, suicidal tendencies, etc)? If so, please explain.*

Are you willing to discuss your health condition at aninterview?

Please proceed to the next section of the application form

Yes No

Anemia

Mental Disorders

Stomach Ulcer

Venereal Disease

Nervous Disorders

Gall Bladder Problems

HIV / A.I.D.S.

Paralysis Surgery

Head Injury

Hay Fever/Asthma

Skin Conditions

Heart Trouble

Jaundice

Eye Trouble

Ear Trouble

High Blood Pressure

Hepatitis

Low Blood Pressure

Intestinal Trouble

Hernia Repair

Arthritis

Recurrent Diarrhea

Recurrent Headaches

Back Problems

Diabetes

Epilepsy

Dislocation of Joint

Kidney Disease

Fainting Spells

Tumor/Cancer

Have you ever had any of the following? Please tick all that apply.

Insomnia

Appendectomy

Shortness of Breath

Tonsillectomy

FEMALES ONLY

Irregular Periods

Severe Cramps

Excessive Flow

Are you pregnant?

Allergies (specify)

Other (specify)

If you have, or have had, any of the above conditions, please provide more information about how this impacts your current state of health.

Is there anything else that you think may be useful for us to know about your medical history or current condition of health?

Do you have any specific dietary requirements?

If so, is your diet preferential or medical? Please explain.*

Yes No

EXPECTATIONS

Please note that if your application is accepted, we will require you to immediately apply for a Police Clearance Certificate. We can offer you guidance on how to go about getting this if you need assistance, but you will need to have the certificate in hand before the start of the programme.

If you are accepted onto the Solid Ground programme, you will be required to conduct yourself in a manner that

is appropriate to a person of influence, and in line with the Christian Faith and the values of Rocklands Centre.

CONDUCTThe Solid Ground team works extensively with children. We take issues of child safety very seriously. We expect that you are above reproach in this regard. At this point, it is essential that we clarify the following:

Have you ever been accused, rightly or wrongly, of behaviour unbecoming of a ministry person, or have you ever been accused of improper conduct regarding children?

Yes No

If so, please explain the situation.*

Please describe all pending and past criminal charges and arrests in any country.*

APPLICANT'S AGREEMENT

I agree to adhere to and abide by all the guidelines and rules of Rocklands Centre and of the Solid Ground internship programme, whether on site or off site, and whether on duty or off duty, for the entire duration of the programme.

I understand that the internship package will include accommodation and food for the duration of the programme, as well as a small monthly allowance.

I agree to immediately apply for a Police Clearance Certificate if I am accepted, and to enter the programme with the original certificate in my possession.

I accept the Rocklands Statement of Faith: (https://rocklandscentre.co.za/declaration-of-faith.html)

I have completed this application honestly and have neither included false information nor omitted information that may impact my eligibility for the Solid Ground internship programme.

If accepted, I consent to be treated by a health professional in the case of emergency, and hereby agree to the performance of such treatment including anesthesia and surgery as the attending doctor or physician may deem necessary.

I accept that Rocklands is not responsible for covering medical costs, and I understand that Rocklands Centre recommends that all interns are covered by personal medical aid or health insurance for the duration of the programme.

____________________Date

____________________ Date

_________________________ Applicant's Signature

_____________________Parent's Signature(If Applicant is under the age of 21)