Form 1A - Basic Information Name *Prefix--Rev.Fr.Dcn.Br.Sr.Mr.Mrs.Ms.Dr.Most Rev.Rt. Rev.First Name *Middle Name *Last Name *Street Address *Apartment, suite, etc.City *State/Province *ZIP / Postal Code *Country *Phone *Email Address *Social Security or National Identification Number *Date of Birth *Place of Birth *Father's Full Name *Mother's Full Name *Family HistoryMarital Status: * Single Married/Civil Partnership Divorced Widowed SeperatedDate of MarriageName of SpousePrefix--Rev.Fr.Dcn.Br.Sr.Mr.Mrs.Ms.Dr.Most Rev.Rt. Rev.First NameMiddle NameLast NameDate of DissolutionDate of SeparationDate WidowedExplain Dissolution of Marriage:Do you have children? Yes NoPlease list your children's names and ages:Military ServiceHave you ever served with or are you currently a member of the Armed or Civil Forces? (List only dates of Active Service in which you actual were in the Military. Do not list any time which you where not on active duty or did not serve within active service.): * Yes NoDates of Active Service:Branch of Active Service:Highest Rank Held while in active service:Type of Discharge from Active Service:Please list all military or civil awards and decorations received while in active service:Dates of Combat Service (In which you served as an active member of the military):Where did you see combat (in active service only):Upload copy of DD-214Max 8 MB per file.Personal HistoryAre you now being, or have you ever been, treated for a chronic physical, mental, or emotional illness? Include experience with 12 step recovery programs. * Yes NoPlease explain:Do you have any significant debts or financial uncertainties? * Yes NoPlease explain:Excluding minor traffic violations, have you ever been convicted of a felony or misdemeanor (including suspension or withdrawal of Driving License)? * Yes NoPlease explain:Have you ever been accused of any crimes involving children or crimes of a sexual manner (rape, incest, molestation, emotional abuse, domestic violence etc.)? * Yes NoPlease explain:Have you ever used, abused, or been addicted to illegal drugs or narcotics; abused over-the-counter or prescribed drugs or medication; or been treated for drug or alcohol abuse and dependency? * Yes NoPlease explain:Have you ever been charged or convicted of any church-related crime in any jurisdiction or church? * Yes NoPlease explain:Have you ever been involved in any public scandal, or allegations that were covered by the press? (If you have, it may not disqualify you from ordination, but we need to know about it, and we do not want to hear about it from a third party. It is in your own interest to tell us, and supply any press cuttings etc. It is for your protection and ours that we need to be fully informed) * Yes NoPlease explain:Submit
