Scientology Crime Syndicate
Life History Form

This form is used by the Sea Org; members joining the Sea Org are required to fill it out completely. It's easy to see why many ex-Sea Org members are reluctant to openly criticize the Church, knowing that the Church knows every detail about every aspect of their personal lives.

From: warrior@electrotex.com (Warrior)
Newsgroups: alt.religion.scientology
Subject: Life Hstory form used by Sea Org
Date: 20 Aug 1997 20:13:31 -0700
Organization: None
Lines: 218
Message-ID: 199708210313.WAA18997@etex.electrotex.com
References: 199707160555.AAA18505@etex.electrotex.com
Reply-To: warrior@electrotex.com
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Life Hstory form used by Sea Org


I thought I would post this "Life History" form which was used in PAC while I was in the Sea Org. The form is NOT copyrighted. The form below is a true copy of a typewritten copy that was given to me by the Ethics Officer of the org. My answers have been omitted in this posting. Sorry! :-) I kept a copy of this form (and my answers) because I had been requested to complete one so often that I grew tired of answering the same questions over and over again. It is a very time consuming action to honestly complete this form. And since we were required to attest that it was true and correct, I did fill this form out accurately.

I humbly request anyone who feels I am a coward to complete this form yourself and mail it to the Office of Special Affairs of Scientology. Note that members not only divulge information about themselves, but about family, friends, employers and spouses too!

There is DAMNED LITTLE Scientology does NOT KNOW about me. Between the information disclosed on this form and the information members divulge in "confessionals", "integrity processing", "counselling sessions", and other "auditing actions", is it any wonder SO FEW ex-Scientologists ever speak out about injustices, abuses, illegalities, etc. witnessed while in the Sea Org? Who amongst us has not sinned?

I stand naked before Scientology.


                                Life History

Name:__________________ Date:  _____________________

                        Post:  _____________________

(answer questions on separate paper and attach)


1. Do you have a psychiatric/institutional history, or have
you ever been a social worker, psychologist or counselor
of any kind? Have you practiced any kind of group therapy?
A. If yes to any of the above, give time, place,
form, event and full details.

2. Have you ever had a willing connection to a squirrel group
or suppressive group?
A. If yes, give full details.

3. Have you ever blown from any Scientology or Sea
Organization? (even if only for a day)?
A. If yes, give full details.

4. Are you connected to anyone antagonistic to Scientology?
A. If yes, give full details.

5. Have you ever threatened or attacked Scientology?
A. If yes, give full details.

6. Have you ever been expelled from the Church?
A. If yes, give full details.

7. Do you have a criminal history of any kind?
A. If yes, give full details (time, place, form,

8. Have you taken illegal drugs?

9. Have you completed the Drug Rundown? When?

10. Have you ever taken drugs since being in Scientology?
A. If yes, please state what drugs you took, and what
training and/or auditing you'd had, when and where
and under what circumstances you took the drugs.

11. Have you ever threatened or attempted suicide?
A. If yes, please give full details.




1. When and where were you born?

2. Education: Please list in chronological order, beginning
with your earliest schooling, every school you have
attended. Use the headings as illustrated below.

3. Employment: Please list in chronological order all jobs
you have held beginning with your first job. Please
explain what you were doing during any period of
unemployment. Use headings.

4. Medical history: Please list in chronological order any
illness, accidents, permanent injury, etc, you have had,
from birth to PT by month and year. Include all childhood
illnesses (i.e. mumps, measels, chicken pox, etc). List
the names and location of any hospitals and sanitoria you
have been in. State also the approximate frequency that
you have had colds, aches and regular pains during your
life, with the time periods. List also any corrective
surgery you have had and where done.

5. Please list your parents' names and adresses (or

6. Please list your parents' PT occupation, and any other
jobs they might have held. Give a brief description of the
type of work they did, the name of the corporation, etc.

7. What is your attitude towards your parents, and what do
you think of them? How do they regard you?

8. Please list the names and adresses of your brothers and
sisters (if any), and what their job history is, where
they live and with who. What is your attitude towards

9. List your friends (even prior to Scientology) and what
sort of relationship you had, and what sort of jobs they
held and are holding now. Also please state what your comm
has consisted of since being in Scientology.

10. What is your marital status? Please list the name of your
present spouse and any past spouses (in chronological
order if more than one), when you married him/her and
where. List also the dates of any separations and/or
divorces and why. (Give month/year for all dates and
maiden names where applicable.)

11. Give a general 2-D history for yourself, including your
earliest sexual experience of any kind, when you started
dating, and the names of all persons involved. Make a
chronological list by month/year of the names of all
persons with whom you have had sexual relationships and
what you engaged in. Approximate the number of times you
carried on any kind of activity, and note any perversions
you engaged in: WHO, WHAT, HOW OFTEN. Be as complete as
you can.

12. Note any instances of homosexual activity from earliest
time to PT. Give WHO, WHAT and HOW OFTEN.

13. List names and ages of children you have.

14. List your interests and hobbies.

15. List all groups and organizations you have ever been
associated with. Include time period, name of group, its
location, what type of group, and what you did in it.

16. List any connections to terminals listed in the following
A. Intelligence organizations
B. Organized medicine
C. Banking industry
D. The Media
E. Goverment
F. Public Relation Firms
G. Psychiatry, psychiatrists, psychologists, etc.



4. Please list any MAJOR ETHICS ACTIONS YOU HAVE HAD, good
and bad, and explain it fully.



1. Please list all drugs you have taken, including medicine
with month/yr time periods as closely as possible. Use
headings as in the illustration below.


1. Please give exact details concerning your current life:
whom you live with, whom you spent your free time with or
run around with, etc. What is your daily routine, what do
you do with your leisure time?



Please attest the data is true and correct.


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