Name _____________
Date of birth __/__/____
Place of birth: Country ______ State_____________ City ___________
Mother’s name ____________________
Fathers name _____________________
E-mail address _________________________________
Phone number __________________
Driver’s License Number ____________________
Please Answer “Yes” or “No” In The Spaces Provided.
1. ____Are you a Christian?
2. ____ 1Corinthians 7:1 says, “It is good for a man not to touch a woman.” Do you believe the Lord really expects you to keep your hands off a woman until you get married?
3. ____How often do you attend services?
a. Once a week
b. Twice a week
c. Three times a week
d. More
4. ____Do you smoke tobacco?
5. How fast can you run
a. 40 yards ______sec.
b. Two miles ____min.
6. ____Do you chew tobacco?
7. What is your blood type:_______
8. ____Other than a speeding ticket have you ever been convicted of a crime? (If yes, please explain and give dates.)
9. ____To your knowledge do you have any STDs?
10. ____Do you have any tattoos? (If yes tell how many, where, and what kind they are.)
___________________________________________________
___________________________________________________
___________________________________________________
11. ____Do you have any piercings? (If yes tell how many, where, and what kind they are.)
___________________________________________________
___________________________________________________
___________________________________________________
12. ____Have you sinned since you got saved?
13. ____Do you have a valid driver’s license?
14. In 50 words or less, describe what “Don’t ever, ever, touch this girl” means to you.
___________________________________________________
___________________________________________________
___________________________________________________
15. ____Do you own a vehicle? (If so give the make and model and list at least four of the preset stations your radio is tuned to.)
___________________________________________________
___________________________________________________
___________________________________________________
16. ____If the need arose could you take your Bible and lead a person to Christ right now? (If so list some of the Bible verses you might use.)
___________________________________________________
___________________________________________________
___________________________________________________
17. ____Have you consume any alcoholic beverages in the last six months? (If so tell when, where, and how much.)
18. ____Have you taken any medication in the last six months that was not prescribed to you? (If so tell when where and how much.)
19. ____Did Jesus make alcoholic wine?
20. ____Have you smoked marijuana in the past six months?
21. ____Have you, other than by accident, ever hit a woman?
22. ____Would you hit a larger woman if she attacked your girlfriend and you were unable to restrain her otherwise?
23. ____Have you ever been in a physical altercation (a fight) with another man? (If so how many times)
24. ____Do you know CPR?
25. ____Have you ever led anyone to the Lord?
26. ____Do you have any gospel tracts on you right now?
27. ____Do you have any children?
28. ____ Are you a member of any secret society such as the Masons, Shriners, skull and bones, etc?
29. ____Have you ever been married?
30. ____Have you ever been engaged?
31. ____Have you been scripturally baptized?
32. ____Have you ever been accused of rape?
33. ____Are your biological parents still alive?
34. ____Are they married?
35. ____Do you work or go to school? (If yes tell where, for how long, and briefly describe your schedule)
___________________________________________________
___________________________________________________
___________________________________________________
36. How much cash do you have on you right now? _________________
37. What is the longest you’ve ever held a job and where was that?
___________________________________________________
___________________________________________________
38. Other than John 3:16 write out a verse of Scripture from memory.
___________________________________________________
___________________________________________________
___________________________________________________
39. Write out another verse from memory.
___________________________________________________
___________________________________________________
___________________________________________________
40. When did you get saved? __________________________
41. Complete the following sentences:
a. If I were to be shot, the last place I would want to be shot is in the _________
b. If I were to be beaten, the last bone I would want to be broken is ___________
c. The one thing I hope this application does not ask is ______________________
d. In the unfortunate event of my untimely death, I would like my ashes scattered
____________________________________________________
e. My greatest fear is _____________________________________
42. What do you want to be if you grow up? _________________________________
43. Where did you get saved? __________________________
44. Have you ever been fingerprinted? Yes ____ No _____
45. What church do you attend? __________________________
46. Are you a member of that church (if not, please give the name of the church you are a member of) Yes ____ No _____
47. What is the longest relationship you’ve ever been in? _____________________
48. How many times have you been baptized? __________________________
49. Did you get baptized before or after you got saved? __________________________
50. What is your pastor’s name? ___________________
51. (Other than playing Call of Duty) List some of your hobbies:
___________________________________________________
___________________________________________________
___________________________________________________
52. Do you have any identifying marks? (Birthmarks, scars, tattoos etc.) Yes ____ No _____ (if yes please explain and give locations)
53. My dentist is ______________________ City ______________ State _______
I hereby swear that all the information supplied above is true and correct to the best of my knowledge.
Signed ____________________________________ Date __/__/____
Thank you for your interest. Please allow 4 to 6 years for processing.