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IF NOT, PLEASE EXPLAIN WHY NOT: _____________________________________________________________________

__________________________________________________________________________________________________________

DID YOU ATTEND WORSHIP SERVICES AS A CHILD? IF SO, WHERE AND HOW OFTEN?

__________________________________________________________________________________________________________

DO YOU PRESENTLY ATTEND WORSHIP SERVICES? IF SO, WHERE AND HOW OFTEN?

__________________________________________________________________________________________________________

DO YOU CONSUME ALCOHOL? ______________ IF YES, HOW OFTEN AND IN WHAT QUANTITY? ______________

HAVE YOU EVER USED ILLEGAL NARCOTICS OR TAKEN PRESCRIPTION MEDICINE NOT INTENDED FOR YOU

OR NOT AS PRESCRIBED? _________________________________________________________________________________

IF YES, PLESE STATE WHEN, WHAT DRUG, AND FREQUENCY: ______________________________________________

___________________________________________________________________________________________________________

YOUR EMPLOYMENT RECORD

List your employment over the past five years beginning with your present employer. If more space is needed

please use the back of this sheet.

1. PRESENT EMPLOYER: ___________________________________________________________________________________

ADDRESS: _________________________________________________________________________________________________

YOUR TITLE/POSITION: ______________________________________DATE EMPLOYED: _____________________________

SUPERVISOR: _____________________________ PHONE NO.: ____________________________FAX NO. ________________

WORK SCHEDULE: HOURS ______________________DAYS __________________________ OVERTIME ________________

YOUR SALARY OR HOURLY WAGE: _____________________________

2. EMPLOYER: _____________________________________________________________________________________________

ADDRESS: _________________________________________________________________________________________________

YOUR TITLE/POSITION: _______________________DATE EMPLOYED: ______________DATE LEFT: __________________

SUPERVISOR: _____________________________ PHONE NO.: ____________________________FAX NO. ________________

REASON FOR LEAVING: ____________________________________________________________________________________

YOUR SALARY OR HOURLY WAGE: _____________________________

3. EMPLOYER: ____________________________________________________________________________________________

ADDRESS: _________________________________________________________________________________________________

YOUR TITLE/POSITION: ______________________DATE EMPLOYED: ______________DATE LEFT: ___________________

SUPERVISOR: _____________________________ PHONE NO.: ____________________________FAX NO. ________________

Personal Data Form And Social Study Information Sheet - Tarrant County Family Court Services Page 5