I. Personal Details Title * - Select -MrMsMrsMissDrPsRev Surname * Given Name * Name as in NRIC * Last 3 Digits + Alphabet of NRIC * Home Address * Postal Code * Telephone No. Home Office Mobile * Email Address * Gender * Male Female Height Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004 Age * Race * Nationality * Occupation * Marital Status * - Select -SingleEngagedMarriedRemarriedDivorcedWidowed Name of Team Pastor * - Select -Asher & Wendy Eng TeamCheng Kim Meng & Huey Teng TeamDaniel & Patsy Gan TeamEugene & Dorothy Tan TeamLoke Mun Tai & Alicia TeamPatrick & Hilary Pang TeamPoh Wee Long & Cristabel TeamRichard & Jenny Ong TeamRoland Lee & Lai Fun TeamSimon & Marilyn Yee TeamTay Chin Kwang & Hsiu Chin TeamWang Guanghan & Melissa Team Name of G12 Leader * Name of Cell Leader * II. Education/Skills/FCBC Equipping Status Highest Education Level * GCE ‘O’ Level GCE ‘A’ Level Polytechnic University Post-graduate Others If Others, please specify Language(s)Specify which languages or dialects you are able to communicate in: English * - Select -FluentModerateA Little Chinese - None -FluentModerateA Little Japanese - None -FluentModerateA Little Tetum - None -FluentModerateA Little Hokkien - None -FluentModerateA Little Cantonese - None -FluentModerateA Little Others (Please specify) Specialised Skills (Please specify) FCBC Equipping Status (Highest level completed) * III. Conversion/Church Affiliation/Christian Service No. of years as a Christian * No. of years as a FCBC member * Are you currently leading an open cell/G12 group? * Yes No Please state other current ministry involvements (FCBC or others), if any IV. Information On Other Matters Have you suffered or are you suffering from any serious illnesses? * Yes No Do you have any physical disabilities or allergies? * Yes No Have you ever suffered from depression, insomnia, or anorexia? * Yes No Have you ever used illegal drugs? * Yes No Have you been dismissed or suspended from the service of any employer? * Yes No Are you a bankrupt or a discharged bankrupt? * Yes No Are you in debt? * Yes No If you answered “Yes” to any of the above questions, please elaborate in terms of the nature/extent/date/duration/reason Terms * By submitting this form, I permit FCBC to contact me in response to my application. Applicants will be required to attend an interview with the Selection Committee.