This form is form individuals with no practicle clergy experience and little or no formal training in theology or divinity.

First Name *
Last Name *
Address1 *
Address2
City *
State *
Zip *
Enter Field Title *
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    Date of Birth *
    Gender*
    Male
    Female
    Other
    Marital Status (optional)
    Married
    Single
    Divorced
    eMail *

    Please list your education level (high school, college, trade) with any honors or degrees recieved.

    Education *

    The following is the Self Disclosure Statements. This information will be held in highest confodentiality. None of this information will be kept accesable on any computer network or the internet.

    Are you aware of any physical, mental or emotional condition that may limit your ability to work with a congregation or individuals or perform your duties once made a clergy member?*
    Yes
    No
    Are you, friends or coworkers concerned about any patterns of alcohol abuse*
    Yes
    No
    Do you think you have a problem with the use of any drugs; Prescription, over the counter or illicit*
    Yes
    No
    In the past 10 years hace you been charged or convicted of any crimes that may be of concern*
    Yes
    No
    Are you, family member or friends concerned about your patterns of gambling*
    Yes
    No
    Have you ever been reprimanded or deposed by a religious organization*
    Yes
    No
    Have you been baptized*
    Yes
    No
    Have you been confirmed*
    Yes
    No

    I hereby affirm that the questions on this page have been answered honestly, completely and to the best of my ability.

    Sign below with MOUSE if no touch screen or FINGER TIP if on touch screen.
    Affirmation Signature *
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    If you have any supporting files in pdf, jpg or png please upload. This can be graduation , baptism or other docs.
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