Medical Volunteer Form

We are currently recruiting Doctors, Nurses, Respiratory Therapists and other medical
professionals for medical outreaches and disaster response.

If you are interested in joining the FDR Medical Team,
fill out the form below to receive more information!

Name(Required)

Do you agree with our statement of faith? The Foursquare Church believes that Jesus Christ is the Savior, Baptizer with the Holy Spirit, Healer, and Soon-Coming King. We stand firm on the foundation set by Hebrews 13:8, which proclaims: " Jesus Christ is the same yesterday, today and forever."(Required)

For the full statement, visit https://foursquare-org.s3.amazonaws.com/resources/Print_Brochure_What_Foursquare_Believes_English.pdf

Today's Date(Required)

Address(Required)

Email(Required)

Phone Number(Required)

Gender(Required)

What is your profession?(Required)

What is your specialty?

Do you have a valid Medical License?

Yes

No, I'm retired

Does not apply to me

Brief medical experience, including any international volunteer work.(Required)

Volunteers raise their own funds for volunteering prior to deployment.(Required)

Have you ever been charged with or convicted of a crime, including either a felony or a misdemeanor?(Required)

Yes

Professional Reference(Required)

Name, Relationship, Phone Number, Email

Pastoral Reference(Required)

Name, Relationship, Phone Number, Email

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Medical Volunteer Form

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