Applicant Confidential Questionnaire

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Introduction & Purpose

We are aware that the questions contained in the form which follows are personal and very sensitive. Jesus is in the business of redeeming sinners and changing lives, so we do not expect anyone’s past to be perfectly "clean." Rather, our concern is with unresolved issues from the past. These issues are sensitive precisely because, unless properly dealt with, they have the power to undermine and destroy you even as you seek to plant or pastor a church. Therefore, we ask these questions both for your protection and ours as a network, but especially for those among whom you intend to minister.
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Introduction & Purpose (continued)

Your answers on this form will only be read by the TCT Network Executive Director and the Assessment Team. It will be kept in a confidential and locked file. However, the assessment team shall respect the legitimate jurisdiction of civil authorities and shall cooperate with them as required by law, unless there is a clear Scriptural reason to do otherwise. You will be consulted in the event there is need for further clarification. If needed, we will request a response from you on all relevant questions. We appreciate your honesty.
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Both the applicant and the applicant's wife should individually complete this form and submit it.
I am the applicant.
I am the applicant's wife.
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I hereby authorize TCT personnel to disclose to the assessment team participants all information disclosed in the application, interview process, and this confidential report.
First Name
Last Name
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Please list your significant financial obligations, including all types of debt and their total amounts: mortgages, major bills, insurance, pledges, credit cards, school loans, and any other items for which you must make provisions. Please include information related to any previous bankruptcies, if applicable.If your spouse has already submitted this information to us for your household, you may state this in the box instead of duplicating the effort.
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Do you have any health concerns that could create a financial burden in the context of church planting or the pastorate? If yes, please explain.
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Do you have any special concerns for your children’s needs (i.e. health, education, physical needs, emotional, etc.)? If yes, please explain.
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Have you ever been charged or convicted of a felony? If yes, indicate dates and please explain.
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Have you or your spouse ever been physically or verbally abusive to each other (1 Tim. 3:3; Titus 1:7)? If yes, please explain.
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Do you or have you used illegal or narcotic drugs (including abuse of prescription medications)? If yes, indicate what type, how recent, and in what quantity.
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Have you ever been involved in any Eastern Religions or occult activities (i.e. tarot cards, Ouija boards, witchcraft, Wicca, new age, etc.)? If yes, please explain.
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Have you ever been a victim of abuse, molestation, or rape? If yes, please explain.
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To what extent have you or your spouse been involved in gambling activities (card games, sporting events, casinos, recreational activities, etc.)?
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Do you or have you (or your spouse) ever drunk alcohol as a means of escape or drink to the point of drunkenness (1 Tim 3:3; Titus 1:7)? If yes, please explain.
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1) Have you ever sexually abused anyone? 2) Have you ever been sexually involved with a minor, while you yourself were legally considered an adult? 3) Have you been accused of or participated in any form of sexual harassment?If yes to any of the 3 questions, please explain.
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To what extent have you or your spouse been involved with pornography, including cable channels, softcore porn (e.g. HBO, Cinemax, Showtime, etc.)? When was the last time (if any) you purposely looked at pornography?
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Do you or your spouse use any Internet protection software (Covenant Eyes, XXX, etc…) and if so, does someone else get a report sent to them? If so who?
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Have you or your spouse ever been unfaithful to one another in your sexual relationship (improper sexual behavior either emotionally or physically)? If yes, please explain.
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Have you or your spouse ever had same-sex or gender dysphoric desires and/or had a same-sex experience or acted on those gender dysphoric desires? If yes, please explain.
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Are you now or have you ever been under a physician’s care for mental or emotional treatment? If yes, please explain.
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Have you or your spouse ever participated in a 12-Step Program or another type of recovery program for addiction or codependency issues? If yes, please explain.
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If any of these areas are unresolved at this time, are you open to get help with resolution?
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Has there been a significant experience of suffering (past or present) that you or your spouse has encountered? How are you or have you dealt with this?Examples: Miscarriage, death of someone close, disease personally or with children, etc.
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Is there anything in your/your husband's personal life, past or present, which you have not yet disclosed that would disqualify you/your husband or is not “above reproach” for serving as an elder of Christ’s Church (1 Tim. 3; Titus 1)? If yes, please explain.
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Have you told the truth about all of the prior statements?
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Certification & Agreement

I hereby certify with my signature that all information submitted in connection with my Confidential Questionnaire is true and correct. I agree that the TCT Network may verify any of the information submitted in support of my application, and I understand that I am under a continuing obligation to advise the TCT Network of any changes which may occur after the Confidential Questionnaire submission. I further certify that if I am accepted as a member of TCT, I will abide by the rules and regulations as listed in the Covenant. I understand and agree that the omission, misrepresentation, or concealment of any significant fact in any statement may be considered sufficient reason for the denial of my membership.
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I hereby certify with my signature below that all information submitted in connection with my Confidential Questionnaire is true and correct.
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Introduction & Purpose

Introduction & Purpose (continued)

Certification & Agreement