Intake Divorce Questionnaire Template (Page 3 of 5) in pdf

INFORMATION ABOUT YOUR EMPLOYMENT

Are you employed? ____________ If yes, state your employer: ________________________________

Job title: ____________________________ Type of job: _____________________________________

Employed since: ____________________________ Gross yearly salary: _________________________

Please state your education and vocational training (including numbers of years you attended high

school and college, if applicable): _______________________________________________________

___________________________________________________________________________________

VI.

INFORMATION ABOUT YOUR SPOUSES’S EMPLOYMENT:

Is your spouse employed? ____________ If yes, state their employer: ___________________________

Job title: __________________________ Type of job: _______________________________________

Employed since: ____________________________ Gross yearly salary: _______________________

Please state his/her education and vocational training (including numbers of years he/she attended high

school and college, if applicable): _______________________________________________________

___________________________________________________________________________________

VII.

INFORMATION ABOUT YOUR PRIOR MARRIAGE(S):

If you or your spouse have been married before this marriage, state name(s) of prior spouse(s) and how,

when, and where prior marriage(s) were terminated: _________________________________________

____________________________________________________________________________________

If there are any children from prior marriage(s) of you and/or your spouse, please list the names and

ages of any children and state with whom such children live: __________________________________

____________________________________________________________________________________

VIII. PRIOR PROCEEDINGS:

Have there been any legal or other proceedings between you and the opposing party? If so, please

describe: __________________________________________________________________________

__________________________________________________________________________________

IX.

RECONCILIATION:

Do you have an interest in reconciliation? __________________________________________________

Does your spouse, as far as you know? ____________________________________________________

Have you tried marriage counseling? If so, when and with whom? ______________________________

___________________________________________________________________________________

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Intake Divorce Questionnaire Template Page 3