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SURGE Online Application Form
The Phase Manager should fill out this application with the help of the applicant. You may click the 'Save' button found on the bottom of this form to save your work at any time. You will receive an email with instructions and a link to this form. For more information about the question found on this form, please reach out to the SURGE director. !IMPORTANT! This form includes an Approval Workflow. Please wait for your response email after your complete and submit your entry before taking further action.
SECTION A | Staff Information
A10. Staff Email
Do NOT enter the SURGE applicant's email. This form does not accept private email addresses.
A11. Region
Select the region that this application refers to.
A12. Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate the application form is being filled out for the first time.
SECTION B | Personal Information
B10. Name
First NameLast Name
B11. Address (center address if currently residing in the program)
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
B12. Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
B13. Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
B14. Email Address
Applicant's email address.
B15. Birth Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
B16. Age
B17. SIN #
Please enter a valid social insurance numberFormat: 000 000 000.
B18. Driver's Licence Number
B19. Driver's Licence Province
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
B19.1 Upload valid driver's licence
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B20. Do you have valid photo ID?
B20.1 Please upload valid photo ID
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B21. Do you have valid passport?
B22. Adult & Teen Challenge of Central Canada Graduation Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearEnter the date when you graduated the Long-Term Program
B24. Marital Status
B25. Spouse Name
First NameLast Name
B26. Spouse Occupation
B27. Number of Children
B27a. Are you the primary care-giver of your children?
B27b. Are you the primary income provider for your family?
B28. List any hobbies, interests, skills and abilities
B29. Have you completed the Experiencing God course?
B29a. If no, why?
B30. Have you completed the prerequisite courses: Discovering Your God Given Gifts, and Managing your Money God's Way?
B30a. If no, why?
B31. List your top 3 God-Given Gifts in order:
B31a. #1
B31b. #2
B31c. #3
B32. Upload your Wired That Way results:
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B33. Upload your Strengths Finder results:
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B31. List your top 3 Character Qualities you need to Strengthen:
B31a. #1
B31b. #2
B31c. #3
SECTION C | Behavioural History
C10. Please upload your vulnerable sector check.
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C11. Please explain why not
All applicants must have updated legal records uploaded on their Client Folders.
C12. Are you currently on probation?
C13. Please explain the conditions of your probation and when your probation will be over
C14. Name of Probation Officer
First NameLast Name
C15. Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
C16. Email
example@example.com
C18. Please upload existing Criminal Record
This can be found in the client's digital file on Google.
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SECTION D | Educational Information
D10. What is the highest level or grade of education you have completed?
SECTION E | Employment History
E10. Please list previous 2 employers and type of work:
E12. Immediate Supervisor
E13. Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
E14. Date Started
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
E15. Date Left
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
E16. Please Upload a Copy of Your Resume & a Letter of Recommendation from the Program Director
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SECTION F | Spiritual
F10. Have You Accepted Christ As Your Personal Saviour and Lord?
F11. Date of Salvation
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
F12. Where?
F13. Name of Home Church
F14. Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
F15. Phone Number
Please enter a valid phone number for the churchFormat: (000) 000-0000.
F16. Pastor
F17. Phone Number
Please enter a valid phone number for the pastor.Format: (000) 000-0000.
F18. Denomination
F19. When and How Did Jesus Become Your Personal Saviour?
F20. How Are You Currently Cultivating Your Spiritual Life and Seeking To Mature in Christ?
F23. Please Share Your Personal Testimony
SECTION G | References
Please List the Name and Email of your Phase Manager and most recent Work Supervisor
G10. Phase Manger
First NameLast Name
G11. Phase Manger Email
example@example.com
G16. Work Supervisor
First NameLast Name
G17. Work Supervisor Email
example@example.com
G18.1. Applicant Signature
G19. Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
G20. Please Upload a Picture of Yourself. The picture should look professional and be a shoulder up headshot. (Not a self taken portrait)
Please ensure the photo is JPG or PNG format!
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G21. Please Upload Exit Plan
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H1.1 Please Upload Your Admission's Project
H1. Admission's Project
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Should be Empty:

SURGE Online Application Form

SECTION A | Staff Information

SECTION B | Personal Information

B31. List your top 3 God-Given Gifts in order:

B31. List your top 3 Character Qualities you need to Strengthen:

SECTION C | Behavioural History

SECTION D | Educational Information

SECTION E | Employment History

SECTION F | Spiritual

SECTION G | References

H1.1 Please Upload Your Admission's Project