Raw Score for this Application: out of - %

Q1. Please enter the following: First Name, Last Name
First Name:

Last Name:

Client ID#:

Telephone (H):

Telephone (C):

Address:

City:

State or Province:

Postal Code:


Q2. Residence History

Q3. Title


Q4. Gender



Q5. Are you a Pastor?



Q6. How long have you been a Pastor?


Q7. Name of the church?


Q8. Date the church was established?


Q9. Did you plant this church?


Q10. Church location: (Street Address, City, State, Zip Code, Telephone Number)


Q11. Church denomination (if applicable):


Q12. If you are not a Pastor, what church do you currently attend?


Q13. Church location: (Street Address, City, State, Zip Code, Telephone Number)


Q14. Pastor's Name?


Q15. Church denomination (if applicable):


Q16. How long have you been attending?


Q17. Are you a member?



Q18. How long have you been a member?


Q19. Social media networks, Please list the links to your personal Twitter, Facebook, and Linkedln accounts. (if applicable)


Q20. Marital Status?






Q21. If married, how long? If divorced, separated, or widowed? How long?


Q22. If married, spouse's name? (First, Middle, Last)


Q23. Spouse's email address and cell phone number?


Q24. Do you have kids?



Q25. If yes, how many?




Q26. What are their ages?


Q27. Do you have any litigation pending that has not reached a final verdict or resolution?



Q28. If yes, please explain why?


Q29. Have you ever been convicted of a Felony?



Q30. If yes, please explain why?


Q31. Have you ever been convicted of a Misdemeanor?



Q32. If yes, please explain why?


Q33. Have you ever been or received First Offender’s status for a crime?



Q34. If yes, please explain why?


Q35. Do you have a history of drug or alcohol abuse?



Q36. If yes, please explain why?


Q37. Would you be willing to submit to drug testing?



Q38. If no, please explain why?


Q39. Did you graduate from High School or Vocational School?


Q40. Most recent College/Ministry/School attended:
SCHOOL’S NAME SCHOOL’S CITY, STATE FROM: TO: FIELD OF STUDY: DEGREE/DIPLOMA:
1 - School of Hard Knocks
City: Macon}
State:
 Month: 3
Day: 10
Year: 1962
Month:3
Day: 9
Year: Engineering
 Engineering BA
2 - Happy School
City: Soona}
State:
 Month: 5
Day: 6
Year: 1970
Month:6
Day: 9
Year: Arts
 Arts BS
3 - Junior College
City: Dunk}
State:
 Month: 3
Day: 3
Year: 1954
Month:3
Day: 6
Year: Fine Arts
 Fine Arts MS
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Q41. Additional College/Ministry/School attended:
SCHOOL’S NAME SCHOOL’S CITY, STATE FROM: TO: FIELD OF STUDY: DEGREE/DIPLOMA:
1 - School of Hard Knocks
City: Macon}
State:
 Month: 3
Day: 10
Year: 1962
Month:3
Day: 9
Year: Engineering
 Engineering BA
2 - Happy School
City: Soona}
State:
 Month: 5
Day: 6
Year: 1970
Month:6
Day: 9
Year: Arts
 Arts BS
3 - Junior College
City: Dunk}
State:
 Month: 3
Day: 3
Year: 1954
Month:3
Day: 6
Year: Fine Arts
 Fine Arts MS
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1 - School of Hard Knocks
City: Macon}
State:
 Month: 3
Day: 10
Year: 1962
Month:3
Day: 9
Year: Engineering
 Engineering BA
2 - Happy School
City: Soona}
State:
 Month: 5
Day: 6
Year: 1970
Month:6
Day: 9
Year: Arts
 Arts BS
3 - Junior College
City: Dunk}
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Day: 3
Year: 1954
Month:3
Day: 6
Year: Fine Arts
 Fine Arts MS
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Q42. Do you speak any other languages?


Q43. Military Service
NAME BRANCH OF SERVICE HIGHEST RANK DATE ENTERED: DATE DISCHARGED: TYPE OF DISCHARGED: DD214 NUMBER:
1 - Army Month: 9
Day: 25
Year: 1959 		Month:9
Day:26
Year:1965 		Honorable 8378337
2 - Navy Month: 3
Day: 6
Year: 1960 		Month:4
Day:6
Year:1963 		Administrative 84848484
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Q44. At what age did you accept Christ?


Q45. Do you believe there is only one true God, eternally existent and manifested in the triune Godhead, three persons equal in power and purpose and authority: God the Father, God the Son (Jesus Christ) and God the Holy Spirit?



Q46. Do you believe all have sinned and come short of the glory of God and are in need of salvation?



Q47. If no, please explain why?


Q48. Do you believe that salvation of mankind comes only by confessing the Lord Jesus Christ and believing that God raised Him from the dead?



Q49. If no, please explain why?


Q50. Do you believe in Jesus Christ’s bodily resurrection and ascension to the right hand of the Father in heaven?



Q51. If no, please explain why?


Q52. Do you believe in the resurrection of the dead to either eternal life with Jesus for the saved or eternal damnation in hell for the unbelieving lost?



Q53. If no, please explain why?


Q54. Do you believe in the deity, virgin birth, and perfect and sinless life of Jesus Christ?



Q55. If no, please explain why?


Q56. Do you believe in the supernatural work in miracles and healing of Jesus Christ?



Q57. If no, please explain why?


Q58. Do you believe in the substitutionary death of Jesus Christ and His bloodshed which atones for sins of the world?



Q59. If no, please explain why?


Q60. Do you believe in the personal return of Jesus Christ in power and glory to rapture a mature church?



Q61. If no, please explain why?


Q62. Do you believe in the observance of the Eucharist (Holy Communion) and in the ministry and baptism of the Holy Spirit, empowering and enabling the Christian to live a holy life in this present world and to minister as Jesus ministered?



Q63. If no, please explain why?


Q64. Do you believe that the Holy Bible (Old and New Testament) is the inspired, inerrant and only infallible, authoritative word of God and the final authority in faith and conduct?



Q65. If no, please explain why?


Q66. If no, please explain why?