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LICENSED MINISTER INTERVIEW GUIDE
Date ____________________
Personal Data
Name _____________________________________ U.S. Citizen ____Yes ____ No
Last First Middle (If No, please provide INS status)
Address _______________________________________________________________
Street City State Zip
Day telephone ____________________ Evening Telephone _____________________
E-mail __________________________ Cell Phone ____________________________
I am currently a member of the ____________________________ congregation, in the
________________________________ District. I have been a member since ______.
Date of birth: Month __________ Day _______ Year __________
Marital status ____Single ____Married ____Widowed ____Divorced ____Remarried
If married, spouse’s name _____________________________________
Please list any children
__________________________________ __________________________________
Name Age Name Age
__________________________________ __________________________________
Name Age Name Age
__________________________________ __________________________________
Name Age Name Age
__________________________________ __________________________________
Name Age Name Age
What is your present occupation?
______________________________________________________________________
______________________________________________________________________
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