3. Are you free from bodily defect or disease? ____
4. What serious illnesses have you had, and when? ________________________ __________________________________________________________________________
5. Have you ever had fits of any kind? __________________ If so how long, and what kind? ___________________________________________
6. Do you consider your health good, and that you are strong enough for the work of an officer? __________________________________________________ If not, or if you are doubtful, write a letter and explain the matter.
7. Is your doctor's certificate a full and correct statement so far as you know? ___________________________________________________________
8. Are you, or have you ever been, married? ___________
9. When and where CONVERTED? ____________________________
10. What other Religious Societies have you belonged to? _________________ __________________________________________________________________________
11. Were you ever a Junior Soldier? _____________________ If so, how long? ________________________________________
12. How long have you been enrolled as a SOLDIER? _______ and signed Articles of War? ____________________