1 Personal
2 Documents
3 Terms

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Qualification:

Course

Biographical Details:

Title

Initials

Surname

Fullnames

Preferred Name

Maiden Name

ID Number

Date of Birth

Gender

Home Language

Citizenship

Race

Marital Status

Passport Number (if Non-RSA)

Permanent Resident? Yes
No

Contact Details:

Cell Phone No.

Home No.

Work No.

Fax No.

eMail Address

Residential Address

Postal Address

Next of Kin

Firstname

Surname

Relationship

Cell Phone No.

Home No.

Work No.

eMail address

SA Citizen? Yes
No

Permanent Resident? Yes
No

Socio-economic Status

Employed
Unemployed Looking
Unemployed Scholar
Unemployed Retired

Unemployed Disabled
Unemployed Homemaker
Unemployed Not Looking

Basic Beliefs

Do You Believe that the Bible is God's Inspired Word and the only infallible guide in matters of conduct and doctrine?

Do you believe in Godhead; that God is one, but manifested in three persons: The Father, The Son, and The Holy Spirit?

Do you believe in the deity of Jesus Christ, that He is God made flesh and the only Mediator between God and man?

Previous/Current Practices

Select any practise you've ever been involved in?

Counselling History

Have you ever been counselled in the last six (6) months concerning personal or family issues? Yes
No

If Yes, Name of Counsellor

Where were you counselled

If Yes, explain briefly

Have you attempted suicide? Yes
No

If Yes, explain briefly

Since your conversion have you been involved in any of the following?

Homosexuality Yes
No

Sexual immorality Yes
No

Since your conversion are you suffering from any addiction Yes
No

If Yes, state

Spiritual Details

Have you been baptized as a believer by immersion in Water?? Yes
No

If yes, when?

Where were you baptized?

By whom?

Which church/denomination do you consider yourself to have been raised?

Church Name?

Address

How long have you attended

Which Church did you attend before?

For how long?

Present/Formely Involvement In Ministry

What is your position in your recommending congregation?

For how long have you held this position?

Medical Data Physical Condition

General Health

Eyesight

Hearing

Heart

Lungs Illness

Conditions You Have Had Or Now Have

Eye/Ear/Nose/Throat Disease

Genito-Urinary Disease

Chemical Imbalance

Respiratory Conditions (e.g. Asthma)

Diabetes / Thyroid / Glandular Disorder Nervous / Mental Complaint Spinal / Muscular Disorder Heart

Disorder (e.g. Heart Murmur) Epilepsy / Seizures / Paralysis Eating Disorder (e.g. Anorexia)

Abnormal Blood Pressure Cancer / Tumour Tropical Disease (e.g. Malaria)

Disorder Of Digestive System Contagious or Transmittable Disease

If a condition selected "Fomerly" or "Presently" above, occured in the past five years, please state the condition

Date of occurence

Length Of Illness

Place Of Hospitalization

Any Permanent Effect?

Are You Currently Taking Any Chronic Medication? Yes
No

If Yes, state medical condition

If Yes, How Often?

If Yes, State Name of Medical Doctor

Do you have any known medical allergies? Yes
No

If Yes, Specify

Do you have any Physical Disability? Yes
No

If Yes, Specify

Have you ever been treated for a mental disorder? Yes
No

If Yes, specify

Incase of Female Applicants

Are You Pregnant? Yes
No

If Yes, Specify Expected Date

Children Details

Do you have any children? Yes
No

If Yes, How Many?

Marital Status Information

Personal Data Of Spouse/Fiancé(e)

Surname

Firstname

Date Of Birth

Age

Country Of Birth

ID/Passport No.:

Occupation

Marriage Details

Date of Marriage

Place of Marriage

Have you or your Spouse been previously Married? Yes
No

If Yes, Please Select Who

if yes, How Many Times?

Date of Last Marriage

Date Of Last Divorce

Is Your Spouse A Professed Christian? Yes
No

Do you have children or other family members that are dependent on you financially? Yes
No

If Yes, Specify How Many

*You Will Be Required to Upload Documents at The Final Stage Of Applying

I hereby declare that the information provided is authentic and correct. I understand and give full permission to view the personal information provided in the form. I understand that my willful dishonesty may render for refusal of this application or immediate termination of application.

I Accept