“Name
Birthdate
Country
Baptized
Religion
Vocation
Married
Children (How many?)
Single State
Talents
Do I act unjustly at any time?
How many times?
Am I always just in my remarks about other people?
Do I respond in dignity with integrity in all matters of obligation?
Do I act authoritative, omitting my obligations and responsibilities?
How many times?
Do I have a habit of being unreasonable?
How many times?
Do I demand of others perfection and allow myself all my mistakes?
How many times?
Do I correct others abusively?
How many times?
Do I embarrass people by my crudeness, my rudeness?
How many times?
Am I indifferent to the needs of others?
How many times?
Am I immodest, causing others to sin?
How many times?
Am I example of love for God in my thoughts, in my words, in my deeds, in my actions?
Do I offend God constantly?
How many times?
Do I use the Ten Commandments as my Guidelines for life?
Do I antagonize others into sinfulness?
How many times?
Do I tempt others into anger, into obscenities, into indecencies, into immoralities, into promiscuities?
How many times?
Do I give my employer his due, in time, respect and work?
Do I steal from anyone, material things, their will, their happiness, their love for another person, their desire to accomplish something good, their ability to shine in the eyes of others through their talents or personality?
How many times?
Do I kill the morale of others?
How many times?
Do I kill the enthusiasm, the interest, the hope, the motivation in anyone else?
How many times?
Do I act impurely, using my selfishness to cause others to sin with the flesh?
How many times?
Do I put anything before God?
How many times?
Do I respond to men and their selfish thinking when this thinking draws me away from the One True Faith I know I must be faithful to?
How many times?
Do I flirt because of my own ego, or because I was attracted to someone else’s spouse?
How many times?
Do I tempt the spouse of another person mentally or physically?
How many times?
How do I treat my moments of anger?
How much time do I spend in promoting Faith in God to others?
How much time do I spend in acts of charity?
What are my thoughts on charity?
How do I feel I should be judged for my charitable acts?
What example am I to other people?
How do I handle my responsibilities at home, at work, at social events?
How much time do I use for prayer in communication with God?
How much effort do I put forth to grow in purity for the good of my Soul?
Dear God,
As I sign this application, I promise You that I have answered all questions as truthfully as I could, bearing in mind that Your Judgment of me will be according to the answers I have given and Your Knowledge of me.
Signature of Applicant
Date
Country”
