аЯрЁБс>ўџ ўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ§џџџўџџџўџџџ   !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHўџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџRoot EntryџџџџџџџџВZЄ žбЄРOЙ2К3=АЧICONTENTSџџџџ ŒCompObjџџџџџџџџџџџџVSPELLINGџџџџџџџџџџџџdўџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџThe responsibility of  caring for family may be offered to family members according to 1 Timothy 5:1. Please note any concerns you would have with us contacting family members. ________________________________________________________________________________________________________________________________________________________________________________________________________________________ Please provide contact information of immediate family members, attach a separate sheet if required. Name: ___________________________________________________ Mailing Address: ____________________________________________________________ Physical Address: ____________________________________________________________ Phone: ________________ E-mail:______________________________ Name: ___________________________________________________ Mailing Address: ____________________________________________________________ Physical Address: ____________________________________________________________ Phone: ________________ E-mail:______________________________ Name: ___________________________________________________ Mailing Address: ____________________________________________________________ Physical Address: ____________________________________________________________ Phone: ________________ E-mail:______________________________ How did you hear of Guardian Angel Services? ______________________ ____________________________________________________________ What service or what areas do you need assistance in at this time? Possible services offered: * Handyman carpentry - Home maintenance repairs ______ * Plumbing ______ * * Minor electrical ______* Painting ______ * Snow removal / yard cleanup ______ * * Errands ______ * Companionship to hoCHNKWKS ŒјŠTEXTTEXT>mFDPPFDPPpFDPPFDPPrFDPPFDPPtFDPCFDPCvFDPCFDPCxFDPCFDPCzFDPCFDPC|STSHSTSH~STSHSTSH~2SYIDSYIDP~SGP SGP h~INK INK l~BTEPPLC p~(BTECPLC ˜~0FONTFONTШ~МEOBJPLC „4STRSPLC ИHMCLDMCLD€і____________File # ____________________________ ќџ Application for Guardian Angel Services An extension of Northern Light Ministries P.O. Box 11 Whitehorse Yukon Y1A 5X9 Phone / Fax 456-7131 Email: nlm@northernlightministries.ca www.northernlightministries.ca The information from this application is for the qualifying of persons applying for services provided by Guardian Angel Services. Please answer all questions accurately; all information is confidential & your privacy is respected. Information provided will not be released to any other party. Applicants contact information. Name: ________________________________________________ Mailing Address: ________________________________________________________ Physical Address: ________________________________________________________ Phone: _________________E-mail: ___________________________ Please provide case worker information if applicable Name: ________________________________________________ Mailing Address: ________________________________________________________ Physical Address: ________________________________________________________ Phone: _________________E-mail: ___________________________ Two Personal references required. Name: ________________________________________________ Mailing Address: ________________________________________________________ Physical Address: ________________________________________________________ Phone: _________________E-mail: ___________________________ Name: ________________________________________________ Mailing Address: ________________________________________________________ Physical Address: ________________________________________________________ Phone: _________________E-mail: ___________________________ usebound family ______ * Laundry ______* * Residential cleaning ______ * Cooking meals ______ * Financial advice and planning ______ * * Other areas not listed - please explain. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How often do you require the services? _______________________________________________ Please provide history pertaining to reason for our services. Please describe any medical / physical challenges that you have at this time. *A doctor's note, signed by your doctor may help in your assessment.*. Include office information pertaining to any medical / physical challenges described above. If required attach applicable information on a separate sheet of paper. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Please provide any other information that would help us in getting to know you as pertaining to this application. Attach extra paper if required. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Have you received similar services before? Yes _____ No _____ If yes, please provide details - when, and who supplied the services. __________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ If yes, please explain why you are seeking service with Guardian Angel Services at this time. __________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________ How long have you required assistance? ______________________________________ If required, are you willing to help a service worker, if you can in the area of your need? Please explain. ___________________________________________________________ Our full service rate will be assessed, based on individual needs up to $50.00 per hour (plus GST) for a 2-person team. The rates for professional services will be determined based on individual needs. This application is not a contract and does not guarantee that the services will be provided by Guardian Angel Services. If accepted, the applicant has the right to accept, refuse or appeal the proposed rates. Based on this application you may be eligible for reduced rates. Are you applying for reduced rates? Yes________ No ________ If Yes, please fill out financial information below. If you are applying for reduced rates please state your financial situation. Maximum amount you can to pay, if accepted for service. $_________ / hour. Are you currently employed? Yes _______ No _______ If yes, please provide employer contact information. _______________________________________________________ You will be contacted at this number to verify your employment. Your privacy is respected with you employer. Gross monthly income. Provide copies of supporting documentation. Example: pay stubs ________________________________________________________________________________________________________________________________________________________________________________________________________________________ Please provide monthly payments and financial obligations. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Net income ________________ Required information continued, non-financial. One of the requirements of receiving help from Guardian Angel Services is church attendance or individual home study of materials and / or ministry provided by Northern Light Ministry. Do you attend a church on a regular basis? Yes ______ Occasionally ______ No ______ If yes or occasionally, are you an active member or just visit? ________ Please provide contact information. ______________________________________________________ ________________________________________________________________________________________________________________________________________________ If no, is there anything that may hinder you from attending services @ Northern Light Ministries? Yes ______ No ______ if yes, please explain. ________________________ ________________________________________________________________________________________________________________________________________________ If you are house - bound are you open to receiving ministry materials that would help you in your area of need? Yes _______ No _______ Briefly explain your spiritual understanding / religious history. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Do you require any more information concerning any question on this application? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Pastors Dale & Rena Mae McDonald of Northern Light Ministries would love to answer any questions you may have. Ph. 456-7131 or email: nlm@northernlightministries.ca Adopt a neighbour program. Would you be willing to donate to help others with similar needs? Northern Light Ministries receives donations to subsidize the rates for services to less fortunate individuals. Are you able to help financially through a one-time donation or regular donations? Yes _____ No _____ If yes, amount $____________ Frequency - One time ________ Monthly __________ Yearly _________ I verify the information provided in this application is true to the best of my knowledge. I understand if information is acquired by Northern Light Ministries that would prove the information false; the services will be suspended until further consultation. Print name____________________________ Date _____________________________ Signed _______________________________ Date application received _____________________ Follow up required - yes / no Accepted - yes terms _______________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________ No_____________________________________________________________________________________________________________________________________________________________________________________________________________________ Reply sent to applicant - Date_______________________ By _____________________ n this application? _____________________________________________________________________________:HJNPRrЂЄЦШќ8HvТ  Z\^ž ЎFHФЦ0 2 : В H р т ^ ` b d f h j l n p Д Ж . 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