First Name *

Middle Name

Last Name *

Full Address: (including Postal Code) *

Telephone (Home)

Telephone (Mobile) *

Email *

Occupation/Profession *

Marital Status * MarriedSingleSeparatedEngagedOthers

If Married, Is this your first Marriage? * YesNo

Are you Born Again? * YesNo

If Yes, What Church?

Date of Salvation *

Is your Spouse Born Again? * YesNo

Is He/She a Worker? * YesNo

Give a Short Testimony of your Conversion *

Have you been baptized by Water Immersion? * YesNo

If Yes, When & Where? *

Have you been baptized in Holy Spirit? * YesNo

If Yes, When & Where? *

When did you Join RCCG & Where? *

Have you been a Volunteer/Worker in any Church before? * YesNo

If Yes, What Church? *

What Dept?

Since When?

The Church reserves the right to run a run a background check on you. Do you object? YesNo

Do you hold any Ministerial Title from previous church? YesNo

Ministerial Status Commissioned MinisterOrdained MinisterOthers