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Translating God
June 26, 2022 | Doug Sauder
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Phone Number
*
Wife's Address
*
Street Address
Do You Have Any Children?
*
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Names & Ages
*
Are you subject to any alimony/child support payments?
*
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How Much?
*
Education
Did you graduate from High School?
*
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Which High School?
*
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*
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*
Degree earned
*
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*
Yes
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Which trade?
*
Did you complete trade school?
*
Yes
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Work History
Start with the most recent work history for each company/position that apply to you
Current occupation
*
Years of experience in current occupation
*
Company 1
Company Name
Address
Street Address
City
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California
Colorado
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State
Phone Number
Position
Start Date
MM
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1922
1921
1920
Company 2
Company Name
Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Phone Number
Position
Start Date
Month
1
2
3
4
5
6
7
8
9
10
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12
Day
1
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1935
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1933
1932
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1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
End Date
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
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1926
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1922
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1920
Company 3
Company Name
Address
City
State / Province / Region
Phone Number
Position
Start Date
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
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2013
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2002
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2000
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1990
1989
1988
1987
1986
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1979
1978
1977
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1972
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1968
1967
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1953
1952
1951
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1949
1948
1947
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1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
End Date
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
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31
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2019
2018
2017
2016
2015
2014
2013
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2011
2010
2009
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2007
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1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Military Experience
Are you a veteran?
*
Yes
No
Branch of Service
*
Highest Rank
*
Years in the service
*
Discharge date
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
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4
5
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1933
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1930
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1922
1921
1920
Discharge type
*
Honorable Discharge
General Discharge (Under Honorable Conditions)
General Discharge (Under Other Than Honorable Conditions)
Bad Conduct Discharge
Dishonorable Discharge
Please explain reason for discharge:
*
Were you ever court-martialed?
*
Yes
No
Please explain reason for court-martial:
*
Medical Information
What is the state of your health:
*
Excellent
Good
Fair
Poor
Declining
Height (ex: 5'10'')
*
Weight (ex: 190lb)
*
Usual Weight (ex: 190lb)
*
Any recent weight changes?
*
Yes
No
List all major illnesses and/or surgeries that you have or have had:
*
Have you ever had a venereal disease?
*
Yes
No
What disease?
*
When did you contract the disease?
*
When were you last tested for HIV?
*
When were you last tested for Hepatitis C?
*
When were you last tested for TB?
*
Do you smoke or chew any form of tobacco (i.e. cigarettes, dip, etc)
*
Yes
No
Are you currently taking any prescription or over the counter medication?
*
Yes
No
Please list any medications you are currently taking:
*
How long have you been taking each medication?
*
Please list any side effects associated with this medication:
*
Have you ever suffered from depression?
*
Yes
No
Please describe:
*
Have you ever been treated for any psychiatric illness?
*
Yes
No
Please describe condition & treatment:
*
Have you ever considered suicide?
*
Yes
No
When?
*
Have you ever attempted suicide?
*
Yes
No
When?
*
Why?
*
Alcohol/ Drug Use History
Please list any rehabilitation centers you have attended:
How many rehabilitation centers you have attended?
*
none
1
2
3+
Name:
*
When:
Completed?
*
Yes
No
Name:
*
When:
Completed?
*
Yes
No
Name:
*
When:
*
Completed?
*
Yes
No
What is/are your drug(s) of choice?
*
At what age was your first drinking/drugging experience?
*
How has your drinking/drugging pattern changed to now?
*
What is your longest period of sobriety in the past two years?
*
When did you last drink or get high?
*
What did you drink/use?
*
Is there any other information about your drug or alcohol use that you wish to share?
*
Criminal History
Number of times arrested?
*
Never
1
2
3+
Charge:
*
Date of Charge:
*
Time Served:
*
Charge:
*
Date of Charge:
*
Time Served:
*
Charge:
*
Date of Charge:
*
Time Served:
*
Have you ever been charged with any sexual crime?
*
Yes
No
Are there any charges pending against you at this time?
*
Yes
No
Court Date:
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
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1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Are you currently on probation/parole?
*
Yes
No
For how long?
*
Name of Probation/Parole Officer:
*
Phone Number
*
Spiritual Background
What is your church affiliation?
*
How often do you read the Bible?
*
How often do you pray?
*
Are you saved?
*
Yes
No
Not sure
When?
*
Briefly describe your testimony and your walk with Christ since that time:
*
Personal References
Please provide 3 personal character references (at least one from a pastor or church staff)
Reference #1
Name
*
First
Relationship
*
Phone Number
*
Reference #2
Name
*
First
Relationship
*
Phone Number
*
Reference #3
Name
*
First
Relationship
*
Phone Number
*