Year of Service Volunteer Program (YOS)
Xavier University
2x2
photo
Volunteer Application Form
A. PERSONAL PROFILE
Name ______________________________________________ Nickname ______________
Last
Sex
First
Middle
____________ Status ______________ Height __________ W eight _____________
Age _____________ Birthday __________________ Birthplace ________________________
Citizenship _______________________________ Religion _____________________________
Home Address __________________________________________________________________
City Address ____________________________________________________________________
Cellphone No. __________________________ Email: _____________________________
Guardian ______________________________ Tel. No. ____________________________
B. FAMILY BACKGROUND
Father __________________________Age _______ Occupation ______________________
Mother __________________________Age _______ Occupation ______________________
Brothers and sisters from eldest to youngest:
Name
__________________________
__________________________
__________________________
__________________________
Age
____________
____________
____________
____________
Civil Status
___________________________
___________________________
___________________________
___________________________
Your position in the family _________________________________
C. EDUCATIONAL BACKGROUND
School/Place
Year Graduated
Honors/Awards
Elem
_________. ______________________________
_____________
_________________
_____________
_________________
_____________
_________________
H.S.
_________. ______________________________
College
_________. ______________________________
Course/Degree
_____________________________________________________________________________
Other Colleges
_________. ______________________________
_____________
_________________
D. SCHOOL INVOLVEMENTS
College organizations to which you belonged and/or major activities you have
participated in:
Org./Activities
Position
Year
_________________________________
_______________________
_____________
_________________________________
_________________________________
_______________________
_______________________
_____________
_____________
Seminars and trainings you have attended :
Name
__________________________
__________________________
__________________________
Conducted by
Year
_______________________
_______________________
_______________________
_____________
_____________
_____________
E. WORK EXPERIENCE
Job Description
_____________________________
_____________________________
_____________________________
Employer
_______________________
_____________
_______________________ _____________
_______________________ _____________
F. TALENTS AND SKILLS
What would you consider as your talents?
_______________________________________________________________________
Skills you feel confident enough doing and those you think you possess
_______________________________________________________________________
Languages and dialects spoken:
Fluently ____________________
___________________
____________________
Fairly ______________________
___________________
____________________
G. MEDICAL HISTORY
Previous/present illness ___________________________________________________
Any health problems that might require medication? __________________________
Year
H. WORK PREFERENCE (rank at least 3)
( ) Community Organizing
( ) Tribal Organizing
( ) Education and Training
( ) Literacy Program
( ) Administrative Work
( ) Project Management
( ) Rural Finance Management
( ) Cooperative Building
( ) Assisting Parish Work
( ) Research and Documentation
( ) Farm Technical Assistance
( ) Issue Advocacy/Coalition Building
( ) Health and Nutrition
( ) Livelihood/IGPs
Others, please specify _____________________________
Are you willing to be assigned anywhere as may be designated by the YOS?
_________ Yes
__________ No
If no, why? _________________________________________________________
I. REFERENCES
( Please give 4 names of people whom know you well and are in the position to judge
your general character and motivation. At least one should be able to judge your
academic standing. Inform that you have chosen them as you references.
Name
Designation
________________________ ____________________
Complete Address
_________________________
_________________________
_________________________
________________________ ____________________
________________________ ____________________
Below is the checklist of requirements by the Program for the applicants.
Check the items that you have already completed. Thank you and good luck!
( ) 2x2 photo
( ) References
( ) Essay
1.
( ) Parents consent
2.
( ) Medical Certificate
3.
( ) Transcript of Record
4.
( ) Interview (during AD)
(during AD)
) Personality Test
Name and Signature of Applicant ___________________________________________
GUIDE QUESTIONS FOR ESSAY:
Please answer each question.
1. How do you describe yourself?
2. After attending the YOS Orientation and activities, how do you describe the
program? What about it that you find significant?
3. Give a brief description of your understanding of social development.
4. How do you see yourself five (5) years from now?
5. What is your greatest fear and hope in life?
6. What three (3) things at this stage in your life do you consider very important to
you and why?
7. How will YOS help you with your plans and ambitions?
8. What are the three (3) traits you feel good about yourself?
9. What are the three (3) things you would like to change about yourself?
10.
What are your other options after graduation aside from joining YOS?
11.
If accepted, what are your expectations from the program?
12.
How long would you like to work in this kind of career?
13.
As part of the application process, are you willing to join follow-up activities
in relation to deepening your orientation and interaction of the YOS program?
( ) Yes
( ) No
Date: ______________
Dear ________________________,
(Parents Name)
Your daughter/son ____________ has applied to join the YOS Volunteer Program Year 2013-2014
batch 20 of volunteer-trainees to work for social, peace and development in various places in
Mindanao. To prepare them, they shall be given a special formation and training during the summer
after their graduation. They shall be sent to our partner NGOs/POs, Dioceses/Parishes and Government
to assist in building cooperatives, giving agro-technical assistance, education and training, health care
programs, value formations and other social support services to the communities.
Just like many generous young people who have grown concerned for others, your child is willing to
commit herself/himself through this program as an active response to the call of service. We are
indeed, in search for such dedicated men and women whose vision of their education is a continuing
responsibility to build, to help and serve especially the less fortunate sectors and communities.
Although, your childs desire to join the Year of Service Volunteer Program is a personal
response, we believe that your own support and blessing in his/her decision is equally important
in our consideration of his/her application to the program. Enclosed are documents to help you
know more about the programs thrust, mission and areas of work. You can also visit us at our
office at Volunteer Center for Peace and Development, Manresa Compound Xavier University,
Fr. W. F. Masterson, S.J., Ave., Carmen, Cagayan de Oro City, mobile number 09261904499.
We wish that beyond understanding your childs desire to be of service, you will appreciate the fact
that giving your YES support would mean an opportunity for wide exposure and enriching
experience for your child and at the same time can be your own contribution to the continuing peace
and development endeavors for Mindanao and the whole society.
Thank you very much. God bless you and your family!
Very respectfully yours,
Signed: Pernalyn T. Beja
Program Coordinator
To the YEAR OF SERVICE PROGRAM (YOS) Xavier University
( ) I am aware of my childs desire to join YOS and I give him/her our blessing.
( ) I am aware of my childs application to YOS but I would like to know more
about the program before giving my consent.
Other comments: ________________________________________________________
________________________________________________________
________________________________________________________
____________________________
Applicants Name
__________________________________
Parents Name and Signature
Date: _____________________________
MEDICAL FORM
_______________________________________
Name of Applicant
TO THE EXAMINING PHYSICIAN. The purpose of this physical exam is to assure the
Year of Service Volunteer Program that the above-named applicant is of good health
and does not have any impediments to working as YOS trainee.
The YOS is a university program that sends graduates of XU and other
universities/colleges to work as trainees in social development usually in rural areas
where life is much simpler and luxuries are absent. A YOS trainee therefore should
be physically and emotionally healthy for such an environment, with fewer problems
to adjust to a new situation.
1. Please indicate whether the applicant is in good health, having no major
ailment or impediment.
2. If the applicant has any impediment/s, please give details.
3. Does the applicant require medication?
4. Are there allergies?
5. Are there dietary restrictions?
6. Are there climatic requirements?
Remarks:
Date: ______________
Physicians Printed Name: ________________________
Signature: _____________________________________
Address: ______________________________________
