Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Are you presently employed

Yes

No

Will your employment affect your role at The Potter's House if part time?

Yes

No

Reveals a growing relationship with Christ.

5

4

3

2

1

Exercises a living faith and trust in God

5

4

3

2

1

Models healthy relationships

5

4

3

2

1

Shows respect for authority

5

4

3

2

1

Brings resolution to conflict

5

4

3

2

1

Perceives needs and expectations of others

5

4

3

2

1

Has visionary perspectives

5

4

3

2

1

Functions as a team player

5

4

3

2

1

Listens with understanding

5

4

3

2

1

Uses influence and position effectively

5

4

3

2

1

Manages personal finances well

5

4

3

2

1

Maintains a healthy and balanced lifestyle well

5

4

3

2

1

Punctual for commitments

5

4

3

2

1