LACA Application English

Date / Time

Image Upload

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First Name

Last Name

Phone/Mobile

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Date of birth

Place of birth

Eyes

Hairs

Height

Do you have a Drivers License?

Yes

License Number

Do you have an Automobile?

Yes

Brand, Model & Plate number

Citizenship

American Citizen

Legal Resident

State ID

Resident Card Number

Marital Status

Single

Married

Separated

Divorced

Widow

Name of Spouse

Childern:

Name

Age

In case of emergency, Please contact:

Tel:

Which ministry would you like to participate in?

Hospitals

Prison

Others

Others:

In a brief paragraph, Please describe what you expect from our organization:

Have you ever been convicted of a Felony?

Yes

Please explain:

Educational Information:

Highest level of education:

Middle School

High School

College

If College, what degree or length of time did you complete?

Have you attended Bible Institute?

Yes

Name of Institute:

Address

Year Completed

Phone/Mobile

Additional Theological education?

Employer Information:

Name of Employer

Occupation:

Supervisor:

Phone/Mobile

Length of time:

Work Schedule:

Address

Church Information:

Name of Temple:

Address:

Name of Pastor:

Phone/Mobile

How many years have you been a member in your church?

Have you accepted Jesus Christ as your personal Savior?

Yes

Have you been baptized?

Yes

Have your been baptized with the Holy Spirit?

Yes

Date / Time

What Ministries are you currently involved in?

I affirm that all information in this application is correct with the understanding that any false information in on this
application will result in its rejection or the immediate dismissal of the person.

Signature

Sign Here

Date / Time

First Name

Last Name

To be completed by your Pastor:

Is he/she a good candidate of testimony?

Yes

If not please explain:

How many years has the candidate been a member of your Church?

Ministries in which this candidate is involved in:

Is this candidate responsible and faithful to his/her church?

Yes

If the status of this candidate changes, would you inform us?

Yes

Pastors’ comments:

Signature

Sign Here

Date / Time

References:

(Please submit 3 references. Family member reference not accepted).

Reference 01:

Name

Phone/Mobile

Address

Reference 02:

Name

Phone/Mobile

Address

Reference 02:

Name

Phone/Mobile

Address