Loving Hands Application 2025

We are excited that God has brought you to Loving Hands. This is the first step on a life transforming journey. The rewards for this process will be worth the effort and provide you with a renewed and abundant life in Jesus. Something you will hear often here is "there are no shortcuts to maturity." Don't try to shortcut the process.

You are applying to enter a Loving Hands Ministries Program.

This is a minimum eighteen month commitment.

If you have not already read the handbook, please stop and read it.

You can find the handbook on our website (www.lovinghands.net).

All answers must be complete to process your application. If the answer does not apply to you write "none" or "n/a".

Once you complete the application and click submit, you must call our Intake Staff within 48 hours to verify your application.

Full Name

Best Contact Telephone

Email Address

Current Address (STREET, CITY, STATE, ZIP)

Who referred you to Loving Hands?

Birthplace

Birth Date*

Age

Race

Height & Weight

Hair & Eye Color

Describe any Birthmarks/Tattoos

Emergency Contact: Name, Address, Phone

Emergency Contact Relationship to You?

Father: Name, Address, Telephone

Mother: Name, Address, Telephone

All Siblings - List the name, age, and location:

Were you Adopted?*

Describe your childhood:

Describe your relationship with your Father:

Describe your relationship with your Mother:

Marital Status*

Marriage Information: Name, Address, Phone Number of spouse or girlfriend.

Describe your current marriage or relationship:

Number of Children*

List the names, ages, address, and who has custody of all your children:

If married more than once, describe prior marriages:

Highest Level of Education:*

For the past three years, list your employers, job title, and city worked. Include periods of not working.

Ever collected Workers Compensation?*

Are you a Military Veteran?*

Describe Military Branch, Service, and Discharge:

Describe all machines, equipment, or tools on which you are experienced or trained:

Is your Driver License valid?*

From what state is your DL or ID issued? What is the expiration date?

Do you receive any form of government income?*

Health Status*

Describe ALL known health conditions:

Describe ALL disabilities or limitations:

List ALL prescription medicines, dosages, and prescribing doctor:

Medical Insurance Information: (provider and coverage)

Describe any mental health diagnosis from a doctor:

Describe any attempts to take your own life with dates:

HIV Positive?*

Last Date tested for HIV*

Hepatitis Positive?*

Last Date Tested for Hepatitis:*

STD Positive?*

Last Date Tested for STD:*

Describe all houses, cars, or property you own:

Describe your use of any form of Tobacco:

Describe your use, quantity, and frequency of alcohol:

Do you consider yourself an alcoholic?*

Describe your use of Cannabis/Pot/CBD in any form:

Describe your other illicit drug use:

Do you consider yourself a drug addict?*

List all substance abuse treatment facilities and dates of attendance including detox centers:

Do you consider yourself a homosexual?*

Describe your involvement with homosexuality, if any.

Currently incarcerated?*

List all counties and states in which you have been arrested:

Currently on Probation?*

If yes on probation, describe the charges, what county, probation supervisor, and how long?

Have you ever been sentenced to prison (not jail)?*

List ALL prison sentences including charges, facility, and years.

Do you believe in God?*

Are you Born Again?*

List your home church and pastor:

May we contact your pastor?*

How often do you attend church?

How often do you read the Bible?

How often do you pray to God?

Finish the sentence: A Christian is someone who . . .

How does a person become a Christian?

K1.Personality*

In a short sentence, how would you describe yourself:

Are you DESPERATE to change?*

L2.Desperate descripiton

Do you acknowledge that sin in your heart is the root cause of your addictions?*

Are you willing to seek Jesus Christ as your only answer?*

I have read the entire Resident Handbook.*

I fully commit to a minimum of eighteen months in the Loving Hands program.*

I fully agree to abide by ALL Rules & Conditions of the Loving Hands Program.*

Anything we should know as your final comments?

Type your name as a signature acknowledging the above commitments.