Raw Score for this Application: 21 out of 31 - 67.7419354839% <br /><br/>Q1. Please enter the following: First Name, Last Name  <br/><b>First Name:</b><input type="text" name="fname" value="" size="40" /><br/> <br />
                <b>Last Name:</b> <input type="text" name="lname" value="" size="40" /> <br/><br />Q2. Gender  <br/><input type="radio" id="1335" value="1335" name="2" checked="checked"> <label for="1335"> Female </label><br />
    <input type="radio" id="1336" value="1336" name="2" checked=""> <label for="1336"> Male </label><br />
    <br />Q3. Title: (Mr., Mrs., Miss, Dr., Pastor, Reverend, Bishop, Evangelist, Prophet, Prophetess, etc.)  <br/> <input type="text" name="3" value="Associate Pastor" size="40" /><br/>
      <br />Q4. Residence History  <br/><br />Q5. Church you currently attend.  <br/> <input type="text" name="5" value="Word of Faith" size="40" /><br/>
      <br />Q6. Church location:   <br/>
                    <textarea rows="3" name="6" cols="50" style="margin-right: 40px; vertical-align: middle;">212 Riverside Parkway, Austell, GA 30168</textarea>
        <br /><br />Q7.  Pastor's name and church denomination?  <br/> <input type="text" name="7" value="Bishop Dale C. Bronner" size="40" /><br/>
      <br />Q8. How long have you been attending?  <br/> <input type="text" name="8" value="11 years" size="40" /><br/>
      <br />Q9. Are you a member?  <br/><input type="radio" id="1343" value="1343" name="9" checked="checked"> <label for="1343"> Yes </label><br />
    <input type="radio" id="1344" value="1344" name="9" checked=""> <label for="1344"> No </label><br />
    <br />Q10. How long have you been a member with this church?  <br/> <input type="text" name="10" value="11 years" size="40" /><br/>
      <br />Q11. Social media networks, Please list the links to your personal Twitter, Facebook, and Linkedln accounts. (if applicable)  <br/>
                    <textarea rows="3" name="11" cols="50" style="margin-right: 40px; vertical-align: middle;">facebook/cournteywright.com</textarea>
        <br /><br />Q12. Marital Status?  <br/><input type="radio" id="1349" value="1349" name="13" checked=""> <label for="1349"> Single </label><br />
    <input type="radio" id="1350" value="1350" name="13" checked="checked"> <label for="1350"> Married </label><br />
    <input type="radio" id="1351" value="1351" name="13" checked=""> <label for="1351"> Separated </label><br />
    <input type="radio" id="1352" value="1352" name="13" checked=""> <label for="1352"> Divorced </label><br />
    <input type="radio" id="1353" value="1353" name="13" checked=""> <label for="1353"> Widowed </label><br />
    <br />Q13. If married, how long? If divorced, separated, or widowed? How long?  <br/> <input type="text" name="14" value="21 years" size="40" /><br/>
      <br />Q14. Spouse's name?  <br/> <input type="text" name="15" value="Curtis Wright" size="40" /><br/>
      <br />Q15. Spouse's email address and cell phone number?  <br/> <input type="text" name="16" value="curtis@wroghtdf.com   770-364-5198" size="40" /><br/>
      <br />Q16. Do you have any litigation pending that has not reached a final verdict or resolution?   <br/><input type="radio" id="1357" value="1357" name="18" checked=""> <label for="1357"> Yes </label><br />
    <input type="radio" id="1358" value="1358" name="18" checked="checked"> <label for="1358"> No </label><br />
    <br />Q17. If yes, please explain.  <br/> <input type="text" name="19" value="Input" size="40" /><br/>
      <br />Q18. Do you have children? If yes, how many? If yes, what ages?  <br/> <input type="text" name="20" value="Yes, 2 children, 37 and 25" size="40" /><br/>
      <br />Q19. Have you ever been convicted of a Felony?  <br/><input type="radio" id="1361" value="1361" name="21" checked=""> <label for="1361"> Yes </label><br />
    <input type="radio" id="1362" value="1362" name="21" checked="checked"> <label for="1362"> No </label><br />
    <br />Q20. If yes, please explain.  <br/> <input type="text" name="22" value="Input" size="40" /><br/>
      <br />Q21. Have you ever been convicted of a Misdemeanor?   <br/><input type="radio" id="1364" value="1364" name="23" checked=""> <label for="1364"> Yes </label><br />
    <input type="radio" id="1365" value="1365" name="23" checked="checked"> <label for="1365"> No </label><br />
    <br />Q22. If yes, please explain.  <br/> <input type="text" name="24" value="Input" size="40" /><br/>
      <br />Q23.  Have you ever been or received First Offender's status for a crime?   <br/><input type="radio" id="1367" value="1367" name="25" checked=""> <label for="1367"> Yes </label><br />
    <input type="radio" id="1368" value="1368" name="25" checked="checked"> <label for="1368"> No </label><br />
    <br />Q24. If yes, please explain.  <br/> <input type="text" name="26" value="Input" size="40" /><br/>
      <br />Q25. Do you have a history of drug or alcohol abuse?   <br/><input type="radio" id="1370" value="1370" name="27" checked=""> <label for="1370"> Yes </label><br />
    <input type="radio" id="1371" value="1371" name="27" checked="checked"> <label for="1371"> No </label><br />
    <br />Q26. If yes, please explain.  <br/> <input type="text" name="28" value="Input" size="40" /><br/>
      <br />Q27. Would you be willing to submit to drug testing?   <br/><input type="radio" id="1373" value="1373" name="29" checked="checked"> <label for="1373"> Yes </label><br />
    <input type="radio" id="1374" value="1374" name="29" checked=""> <label for="1374"> No </label><br />
    <br />Q28. If not please explain.  <br/> <input type="text" name="30" value="Input" size="40" /><br/>
      <br />Q29.  What word best describes your current health status if you were to compare yourself to your peers?  <br/><input type="radio" id="1376" value="1376" name="31" checked="checked"> <label for="1376"> Excellent </label><br />
    <input type="radio" id="1377" value="1377" name="31" checked=""> <label for="1377"> Good </label><br />
    <input type="radio" id="1378" value="1378" name="31" checked=""> <label for="1378"> Fair </label><br />
    <input type="radio" id="1379" value="1379" name="31" checked=""> <label for="1379"> Poor </label><br />
    <br />Q30. If fair or poor, please explain.  <br/> <input type="text" name="32" value="Input" size="40" /><br/>
      <br />Q31. Do you have any recurring medical or physical challenges that could influence your ability to participate in a long-term church planting program?  <br/><input type="radio" id="1381" value="1381" name="33" checked=""> <label for="1381"> Yes </label><br />
    <input type="radio" id="1382" value="1382" name="33" checked="checked"> <label for="1382"> No </label><br />
    <br />Q32. If yes, please explain.  <br/> <input type="text" name="34" value="Input" size="40" /><br/>
      <br />