NM Team Health and Lifestyle

Please note that as you are filling out the questions below there isn't a way to save your answers. You must fill out the document fully at one time or save answers in a word document to finish later.

Personal Information

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Name *

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Last

Health and Lifestyle

Some of the questions in the questionnaire are fairly personal. Please know that this information will be kept strictly confidential. We encourage you to answer honestly and prayerfully.

As an applicant, we want you to understand a past problem with illegal drug use and/or immoral behavior will not prevent you from being considered provided: (1) It can be determined that your current convictions are strong and consistent with the Bible. (2) A significant track record of an obedient Christian life has been established. In addition it is important for us to know about any current or previous mental or medical health concerns that may intensify or reoccur during times of stress such as missions service or moving to a new culture.

If you answer YES to any of the following questions, please share some about that area and/or what your current convictions are on the subject. If no, please indicate with "N/A" in the box.

Do you have a close friend or accountability partner who is also applying for this project? If so, who? *

Are you currently in a dating relationship? If so, with whom? *

Do you follow a special diet? If so, please explain. *

List all allergies (food, medicine, plants, seasonal, etc.) and explain the severity of them. *

Do you have any health/physical limitations that would limit long-term standing, sitting, walking, reaching, bending, stooping, lifting, or squatting? If yes, please explain as much as you're able. *

Do you have any current medical conditions that require prescriptions or routine doctor visits? If yes, please explain as much as you're able. *

List all medications you take on a regular basis and the reason you take them. *

Have you had a voluntary sexual relationship/encounter with a member of the opposite sex, other than your spouse, in the last 12 months? If “yes,” please explain. It is not necessary to share the details. Please let us know how you have dealt/are dealing with it. *

Do you currently use or have used 1) alcohol, 2) tobacco, or 3) marijuana, in the last 12 months? If “yes,” please explain for any or all three. *

Have you ever been accused of or charged with child abuse or a crime involving or related to a child or children (meaning an individual under the age of 18)? *

Do you have a police or prison record? If “yes,” please explain. *

Have you ever used narcotics, hallucinogens, illegal drugs, or have you abused prescription medication? If “yes,” please explain. *

Have you ever been or are you now involved in a homosexual lifestyle? If “yes,” please explain. *

Have you engaged in pornography of any kind in the last 12 months? If “yes,” please explain (how often, how recently, etc.). *

If you have stopped engaging in internet pornography, to whom are you accountable? *

If you have not stopped, what steps are you willing to take to correct this problem? *

Have you ever struggled with an eating disorder such as bulimia or anorexia (or experienced bulimic or anorexic tendencies)? If “yes,” please explain. *

Is there anything in your past or present that would hinder you in any way from effectively ministering to children or youth? If “yes,” please explain. *

Is there anything in your life that if made known would hinder or embarrass your witness, your church or the Baptist Convention of New Mexico? If “yes,” please explain. *

I wish to make clear my understanding that the Baptist Convention of New Mexico assumes no responsibility for loss of property, damage to same, personal harm or illness that may occur; and I, for myself, my heirs, executor, administrators, distributes, and assigns, in consideration of my admission to volunteer service and other good and valuable considerations, do hereby absolve said Baptist Convention of New Mexico and hold it harmless from any claim or demand which I or they might conceivably assert upon the basis on the foregoing.
I understand that I will be under the policies of the Baptist Convention of New Mexico. I agree to immediately abstain from the use of tobacco products, cannabis products, alcoholic beverages, illegal drugs, and any other behavior that would hinder Christian ministry. I understand that a breech of this contract will be cause for dismissal and return home at my own expense.
I hereby give the Baptist Convention of New Mexico permission to authorize a background check on my personal history and records.

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Date *

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NM Team Application

Health and Lifestyle Questionnaire

Personal Information

Health and Lifestyle