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SPIRITUAL CONDITION AND BACKGROUND (CONTD):
16. FIELD SERVICE: In what year did you begin to go out in field service?
17. HOURS: What are your average hours in field service for the past six months?
If average hours are below ten, explain why:
18. PIONEER: Since when have you been a regular pioneer?
What are your hours for each of the last six months? 1) 2) 3) 4) 5) 6)
If average hours are low, explain why:
19. If you were DISFELLOWSHIPPED or DISASSOCIATED in the past, were you REINSTATED within the last five years? ( )Yes ( )No
When?
20. Were you reproved by a judicial committee within the last three years? When? ( )Yes ( )No
21. MORALS: Are you of good moral standing and habits? ( )Yes ( )No
Do you listen to any heavy metal, RAP, or other music inappropriate for a Christian? (See g93 6/7 pp. 3-11.) ( )Yes ( )No
Do you watch material inappropriate for Christians, such as R-rated movies/videos? (See g92 11/8 pp. 4-10.) ( )Yes ( )No
Have you ever had a homosexual relationship? ( )Yes ( )No
If you answer yes, please explain:
Have you ever engaged in child sexual molestation, If so, when? (See w97 1/1 pp 25-9, w97 2/1 p. 29.) ( )Yes ( )No
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HEALTH CONDITION: Please let us know your state of health:
22. Your HEIGHT: WEIGHT:
23. PHYSICAL HEALTH: (Excellent, Good, Fair) EMOTIONAL CONDITION: (Excellent, Good, Fair)
24. PHYSICAL DISABILITY: Do you have any? ( )Yes ( )No
If yes, describe:
25. ACCIDENTS: Have you ever been injured in an auto accident, or been involved in any other serious accident that caused you injury? ( )Yes ( )No
If yes, explain when it occurred, the nature of the injury, the treatment, and any current effects from the injury:
26. Do you or any members of YOUR IMMEDIATE FAMILY have a history of NERVOUS or EMOTIONAL DISORDERS?
(e.g. major depression, panic attacks, chemical imbalance, paranoia, schizophrenia, attempted suicide) ( )Yes ( )No
If yes, explain:
Have you ever taken medication or been treated for NERVOUS or EMOTIONAL DISORDERS? ( )Yes ( )No
If yes, explain:
27. Are you troubled with or have you ever been troubled with DIABETES, EPILEPSY, FAINTING SPELLS, HIV, SEXUALLY TRANSMITTED DISEASES, TENDINITIS, REPETITIVE STRAIN INJURIES, CARPAL TUNNEL SYNDROME, HEART DISEASE, HIGH BLOOD PRESSURE, HEPATITIS, TUBERCULOSIS, or other CHRONIC INFIRMITIES? ( )Yes ( )No
If yes, explain:
28. Have you ever been hospitalized or had surgery? ( )Yes ( )No
If so, when and for what reason?
29. Are you currently taking any prescription medication? ( )Yes ( )No
If so, explain what medication and what condition is being treated?
30. Are you troubled with or have you ever been troubled with ASTHMA? ( )Yes ( )No
If yes, please explain in detail:
How often do you have ASTHMA attacks? What medications do you take to control the ASTHMA?
31. Are you in need of, or are you receiving, orthodontic treatment, or any other extensive dental treatment? ( )Yes ( )No
If yes, explain:
If under treatment and accepted to Bethel, are you prepared to cover the cost of completing your dental treatment in a dental facility outside of Bethel? ( )Yes ( )No
32. DRUGS: Have you used drugs other than for medical treatment? ( )Yes ( )No
If yes, which? For how long? From: To:
Describe any PRESENT EFFECTS of this drug experience you NOW have:
33. EYESIGHT: Do you have (Good, Poor) eyesight? Do glasses correct it? ( )Yes ( )No
34. HEARING DEFECT: Do you have any? ( )Yes ( )No
If yes, describe:
35. SPEECH DEFECT: Do you have any? ( )Yes ( )No
If yes, describe: