The Wandering Samaritan | New Samaritan Application

PERSONAL INFORMATION
Name*
First Last
Date of Birth
MM slash DD slash YYYY
Nationality*
Current Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email Address:*
Enter Email Confirm Email
Phone Number*

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SOCIAL & CONTACTS
Skype Username:
Facebook Page:
Twitter Handle:
Website/Blog URL (if applicable):
Upload a Photo
Accepted file types: jpg, gif, png, pdf, Max. file size: 1 MB.
A nice photo of yourself so we know who we are talking to!

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TRAVEL INFORMATION
Where are you traveling to?*

Please list all countries you know you will be visiting, as well as any strong possibilities.
When are you planning to travel?*

Please list tentative date range, and how likely you are to confirm those dates.
Are your flights booked?*
Are you traveling alone?*
If others, tell us a little bit about them
What is your favorite place you've ever visited, and why?*
Have you ever worked with us before?*
How did you hear about us?
Which one or Who?

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LONG FORM SECTION
Describe yourself in one sentence. Don't be shy. Run-ons allowed!!*
Why do you want to be one of our Wandering Samaritans?*
Tell us about your education and/or work experience.*
Describe how you've gone "off the beaten trail" on one of your prior travels.*
Tell us about a random, impromptu experience you’ve had with a stranger?*
Doesn't necessarily have to be during travels.
Describe a time you were way outside of your comfort zone. How did you manage the situation, deal with your doubts/anxieties, and persevere through it all?*
Tell us about a time you encountered something where you wish you could have "done something" but were unable, though it has always stuck in your mind. What happened?*

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REFERENCES
We will not contact them until after we have spoken with you. But please provide us with contact information below now, for ease of processing.
Personal Reference
First Last
Relationship
Phone
Email
Professional Reference
First Last
Relationship
Phone
Email

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PERSONAL INFORMATION