Programs Coordinator Application Form All fields marked * must be completed before the form can be submitted. IMPORTANT: In order to submit this form you will be required to attach a resume, so please have your resume as a Word of PDF document available for attachment when requested near the end of the form. (.doc, .docx or .pdf files only) Name* First Last Email* Phone (Day)Phone (Evening)Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Date of Birth* MM DD YYYY Gender*[Select]FemaleMaleOtherCitizenship*Are you legally able to work in Canada?*Please tell us why you are applying for the Programs Coordinator position:*Please describe your experience related to this position and any training you have had:*How would you describe yourself? What are your strengths and weaknesses?*Have you previously lived in an intentional community? If yes, please briefly describe your experience:Are you a trained yoga teacher? This is not essential, but if so, please tell us where you trained, in what style, and for how many hours (e.g. 200, 500). Please also provide details of your teaching experience to date.Please describe your previous experience with yoga or other spiritual practices:*Do you foresee any difficulty in adopting the lacto-vegetarian diet described in the Centre guidelines?*Do you have any special dietary needs?Do you currently smoke cigarettes?*Smoking of any kind is not permitted on the Centre property.Please list any allergies, indicating the severity of the allergy and any precautionary measures you take. If none, please state "none".*How did you hear about this opportunity?*[Select]Friend/RelativeYoga teacherInternet searchBrochure/FlyerMount Madonna CenterGood Works websiteOtherAre there any other comments you'd like to add to your application?Medical HistoryOver the years we have had hundreds of volunteers living at the Centre, and occasionally medical emergencies have arisen (e.g. diabetic coma, mild seizures). In such an event it is important that we have an understanding of the person's medical history. This is the only reason we require this information and it will be kept strictly confidential. Please answer the following as accurately as you can. Please check any of the following conditions that apply (past or present), or select "none of the above".* Diabetes - Type 1 Diabetes - Type 2 Coronary Heart Disease Epilepsy Chronic Fatigue Syndrome Neurological Disorders & Symptoms (nerve pain, numbness, tingling) Cancer Depression Bipolar Disorder OCD or other anxiety disorder Seizures Chemical Dependency (nicotine, alcohol or other drugs) Eating Disorders (anorexia, bulimia) None of the above Are there any other mental or physical health issues we should be aware of? If not, please state none.*If you do have a medical condition, please describe how it is being managed including forms of treatment and all prescribed medication:* I have read the Centre Guidelines. and agree to their terms. Please attach your resume (.doc, .docx or .pdf files only).*Accepted file types: doc, pdf, docx.