APPLY

SECOND TIMOTHY DECIPLESHIP MINISTRIES

PLEASE FILL OUT THE APPLICATION BELOW AND CLICK SEND

INCOMPLETE APPLICATIONS WILL BE REJECTED!

Please answer all questions honestly and completely.

What is your full legal name, address, phone number, and DOB?

First: Middle: Last:

Street: City: State: Zip Code:

Enter your email address: Enter your phone number:

Date of Birth:

What is your permanent mailing address?

Street: City: State: Zip Code:

Who is your emergency Contact?

First: Middle: Last:

Street: City: State: Zip Code:

Enter their phone number:

Select how they are related. Father Mother Brother Sister Friend Spouse Child Other

What is your marital Status?

Single Married Divorced Widowed

Is the person applying the one filling out this form?

Yes No

Name and phone number of person filling out this form if answer above is no.

First: Middle: Last:

Phone number:

We are only able to accomidate men at this time. Please select your sex below.

Male Female

Do you smoke or use any nicotine products, including chewing, dipping, and vaping?

Yes No

Are you willing and able to work?

Yes No

Are you legally allowed to work in the United States?

Yes No

If you served in the U.S. military select a branch:
Army Marine Corps Navy Air Force Space Force Coast Guard

What Christian faith-based rehab are or were you in?

Who do we contact? Thier address, and phone number.

Your graduation date, and Length of stay?

Are you currently working? If so, name of your employer, who to contact, their address, and phone number.

Do you have tranportation? If yes year, make, model, year and operating condition of your vehicle.

List all medications you are currently taking, prescribed by a physician, and self-prescribed.

Name three books you have read and tell us why you like them.

What type of study habits do you have?

How have you helped others?

Tell us about your desire to follow Jesus Christ.

Do you have a calling on your life? Tell us about it.

Tell us your testimony, what addictions you had and how you overcame them. Provide details and tell it in a story format.

What habits do you have, good and bad? What do you need to work on?

List the social media platforms you are on past and present and how to look you up on each of them.

How did you hear about Second Timothy Discipleship Ministries? Tell us in your own words.