PRIEST PERSONNEL RECORD

REVEREND ______(Full Legal Name)

BIRTH: Date: ______Location: ______Nationality: ______

CITIZENSHIP(s): Please attach copy of Passport and Visa photo pages. Present: ______Date (if Naturalized): ______

PARENTS: Father’s Full Name: ______Mother’s Name with Maiden Name: ______

BAPTISM: Date: ______Church Name, Location:______

PERSONAL CONTACT INFORMATION: Work Phone: ______Work Email: ______Cell Phone: ______Personal Email: ______Alternative Phone: ______Alternative Email: ______

I. EMERGENCY CONTACT INFORMATION:

Emergency Contact 1: Full Name: ______Relationship: ______Address: ______Phone: ______City, State, Zip: ______Cell: ______

Emergency Contact 2: Full Name: ______Relationship: ______Address: ______Phone: ______City, State, Zip: ______Cell: ______

Do you have a Medical Directive? _____ YES _____ NO If yes, where? ______

Medical Allergies: ______

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II. EDUCATION:

Please attach a current Curriculum Vitae, as well as a current Government issued Photo I.D. if no passport provided in Section 1.

LANGUAGES YOU ARE FLUENT IN: All Oral Languages: ______

All Written Languages: ______

III. ORDINATION INFORMATION:

DIACONAL ORDINATION: Date: ______Location: ______Ordaining Bishop: ______Ordained for What Diocese: ______

PRESBYTERAL ORDINATION: (Priestly) Date: ______Location: ______Ordaining Bishop: ______Ordained for What Diocese: ______

EXTERN PRIEST ORDAINED FOR ANOTHER DIOCESE FIRST ASSIGNMENT IN DIOCESE OF DALLAS: Date: ______Location: ______Assignment: ______INCARDINATION REQUESTED: ______YES _____ NO If requested, date:______Date of Incardination: ______

RELIGIOUS CONGREGATION: ______FIRST ASSIGNMENT IN DIOCESE OF DALLAS: Date: ______Location: ______Assignment: ______TEMPORARY VOWS: Date: ______Location: ______SOLEMN VOWS: Date:______Location: ______

Reverend ______Date: ______

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IV. PARISH APPOINTMENTS SINCE ORDINATION (including outside Diocese of Dallas):

DIOCESE PARISH, LOCATION APPOINTMENT/TITLE DATES

V. OTHER APPOINTMENTS / HONORS (Consultor, Dean, Committee, Papal Dignities, Etc.):

DIOCESE LOCATION/ DEANERY TITLE DATE/TERM DATES

Reverend ______Date: ______

PAGE 3 of 4 VI. OTHER INFORMATION FINAL ARRANGEMENTS: Do you have a will? ______YES ______NO Does Diocese have a copy of your current will? ______YES ______NO

CONTACT IN CASE OF INCAPACITATION OR DEATH:

Full Name: ______Relationship: ______Address: ______Phone: ______City, State, Zip: ______Cell: ______

Where do you wish to be buried? ______

VII. ADDITIONAL NOTES: ______

OFFICE USE ONLY: Date of Death: ______Location: ______Cause of Death: ______Place of Burial: ______Location: ______

Reverend ______Date: ______

PLEASE KEEP ALL CONTACT INFORMATION, EMERGENCY CONTACT INFORMATION, MEDICAL INFORMATION AND FINAL ARRANGEMENT INFORMATION CURRENT BY FILLING OUT AN ADDENDUM FORM WHEN YOU HAVE ANY CHANGES AND EMAILING [email protected]. ASSIGNMENT CHANGES WILL BE UPDATED BY THE OFFICE OF THE CHANCELLOR. THANK YOU.

REVISED: November 2019 Signature: ______Date: ______

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