1. Today's Date Position applying for
2. Name

   * First Name Middle Name * Last Name Preferred Name
3. * Gender

   Male Female
4. * Address

   Street Address City State Zip
5. Contact

   * Home Number Work Number Cell Number Fax Number * E-mail Address

1. Single Engaged Married Married Date Widowed Widowed Date Divorced Divorced Date
2. Name of spouse/fiancé(e)

   Last First Middle
3. Children [Add Another Child]

   Full NameGenderBirth Date

1. * Please describe your professional skills set
2. Are you licensed? If so, in what field? When does your license expire?
3. * How did you become interested in/acquainted with B2R & Muhabura University?

1. * Are there any circumstances (aging parents, children's educational needs, personal factors) that might affect your availability or placement? Yes No

   If so, please describe
2. * What is your potential transition timeline?
3. * What position do you feel you are most qualified for?

1. Please give name, address, phone number and e-mail address (if available) of the following individuals. Do not include family members as references.

2. * Pastor
3. * Person to whom you are most accountable spiritually other than your pastor
4. * Employer or former employer
5. * Friend, co-worker or colleague

We believe the Bible to be in the inspired and only authoritative Word of God. (II Timothy 3:16)

We believe that there is one God, eternally existent in three persons: Father, Son, and Holy Spirit. (I John 5:6-8)

We believe in the deity of our Lord Jesus Christ, in His virgin birth, in His sinless life, in His miracles, in His vicarious and atoning death through His shed blood. We believe in His bodily resurrection, in His ascension to the right hand of the Father, and in His imminent and personal return in power and glory. (I Corinthians 15:3,4; I Peter 2:18-24; & John 3:16)

We believe that for salvation of lost and sinful man, regeneration by the Holy Spirit is absolutely essential. This is brought about, not by works, but by faith in the work of Jesus Christ on the cross as a sacrifice for the sins of the world. (Romans 3:21-30; Galatians 4:4-7; Ephesians 2:8,9; I Thessalonians 4:13-18; Revelation 22:20)

We believe in the resurrection of everyone, both the saved and the lost; the saved unto the resurrection of life; and the lost unto the resurrection of damnation. (John 5:24,28,29)

I affirm that all information provided on this application is true and complete to the best of my knowledge and belief.

I authorize Bridge2Rwanda or Muhabura University to investigate all statements made and information provided on this application, in any resume I may submit and in any interview in which I may participate.

I authorize B2R and its agents to verify any information related to my application or resume. I also authorize individuals, schools, employers, and law enforcement or government officials to freely release any information concerning my background, and hereby release any and all of them from any liability for doing so.

If appointed to a position with B2R, I will fully accept and adhere to the Mission and Vision of B2R.

If appointed to a staff position with B2R, I agree to accept the responsibility to raise personal support necessary to work for B2R & Muhabura University if required for the appointed position.

I understand that this application does not constitute an offer of employment and that it does not create, nor is it intended to create, a contract of employment.

I understand that employment with B2R & Muhabura University is terminable at will, which means that employment with B2R & Muhabura University can be terminated at any time with or without prior notice, warning or disciplinary action, and for any or no reason, with or without cause.

I have read, understand and consent by my signature to these statements.