name: date - epc.org · epc personal information form 1 form updated february 2018 name: date: the...

EPCPersonalInformationForm FormUpdatedFebruary20181

Name: Date:

TheEPCMinisterialVocationCommitteeandOfficeoftheStatedClerkprovideresourcesandadvicetobothpastorsandcongregationalsearchcommittees.Tothatend,weaskcongregationsandministerstocompleteinformationformsasanintroductiontoeachother,andasafirststepintheprocessofcallingaministerforacongregation.Forboththeindividualpastorandthecongregation,thisisanopportunityforself-studyandforevaluationofcurrentministryandgoals.Thiscallsforhonesty,effort,andcommitmenttoopencommunication.MinistersandCandidatesarewelcometosendcompletedPersonalInformationFormstoSearchCommitteesforpositionsinwhichtheyhaveinterest.Nopriordenominationalapprovalisnecessary.CompletedformsalsoshouldbesenttotheOfficeoftheGeneralAssemblyattheaddressbelow,incareoftheStatedClerk.CandidatesUnderCareofpresbyteriesarerequiredtosubmitacompletedPersonalInformationFormbeforewrittenordinationexaminationsareissued.ForthoseseekingtotransferordinationcredentialstotheEPC,seetheinformationonwww.epc.org/transferringtotheepcbeforefillingoutthisform.

Ifyouneedadditionalspacetoansweranyquestions,attachaseparatesheet(pleaseensurethatthequestionnumberisincluded).

Contents:

Part1 StatementofConsent Part4 MinistryPreferencesandHistory

Part2 PersonalInformation Part5 Appraisal

Part3 Narrative Part6 BackgroundDisclosure

EPCOfficeoftheGeneralAssembly5850T.G.LeeBlvd.,Suite510

Orlando,FL32822

407-930-4239407-930-4247(fax)

[email protected]

www.epc.org


Part1:StatementofConsent*

WearecalledtohonestyandacommitmenttoopencommunicationasweseektobuildthebodyofChrist.Inthatspirit,weaskthatyouconfirmyouragreementtothefollowingstatementsbyyoursignaturebelow:

IattestthattheinformationcontainedinmyPersonalInformationFormistrueandcompletetothebestofmyknowledge.

Iauthorizethepersonsandentities,suchasmembersofsearchcommitteesofaprospectivecallingbodyorappropriatestaffpersons,tomakeinquiriesregardingallstatementscontainedinmyPersonalInformationForm.Ialsoauthorizeallpersonsreferredtoasreferences,membersofcongregationsIhaveservedorpersonal/professionalcolleagues,tosupplyverificationoftheinformationprovidedinthePersonalInformationForm.Iunderstandthatsuchpersonsmaycommentonandstatetheiropinionsregardingallmattersaddressedintheprofileincluding,withoutlimitation,mybackgroundandcharacter.Toencouragesuchpersonstospeakopenlyandresponsibly,Iherebyreleasethemfromanyclaimsorliabilitiesarisingfromtheirresponsesandcommentsifmadeingoodfaithandwithoutmalice.

IauthorizestaffoftheOfficeoftheStatedClerktocirculate,distribute,andotherwiseshareinformationgatheredinconnectionwithmyPersonalInformationFormtorepresentativesofcallingbodies.IherebyreleasetheEvangelicalPresbyterianChurch,itsagencies,andallcontractorsoremployeesoftheEvangelicalPresbyterianChurchoritsagenciesfromanyclaimsorliabilitiesinconnectionwiththePersonalInformationFormoritsdistribution.

IunderstandthatImayreceivecopiesofallwritteninformationwhichissubmittedtotheOfficeoftheStatedClerkinconnectionwiththePersonalInformationForm,ifImakearequestinwriting.Imaysubmitadditionstomyfiletosupplementorreplytoanymattersincludedinmyfile.

*Acopyofthisconsentformwillbeavailabletoreferencesources.

Iamabletoconsideracallatthistime:

cYes cNo cPossibly

ItisunlikelyIwillconsideracallbefore:

Signature:______________________________________________________DateSigned: ___________________________

PrintedorTypedName:


Part2:PersonalInformation(pleaseprintortype)

1. Name:____________________________________ ________________________________ _________________________________(Last) (First) (Middle)

PreferredAddress:

AlternateAddress:

PreferredPhone:________________________________________________________cCell cWork cHome

AlternatePhone: ________________________________________________________cCell cWork cHome

Email: _________________________________________________________________________________________________________

2. WorkHistory:

PreviousMinistryPositions Dates

Present/LastPosition(ifyouarecurrentlynotinaministryposition) Dates


Name:

3. OrdinationStatus

Ordainedby(church/city/state):

OrdinationDate:

Ifnotordained:

ChurchMembership(church,city,state):

CandidateUnderCareof(denominationandpresbytery):

since(date):

4. EducationalBackground:

a. NameofInstitution DatesAttended DegreeAchieved

b. ContinuingEducation/ProfessionalDevelopment(pleaseincludedates):

c. CommunityandCivicActivities:


Name:

d. PresbyteryandGeneralAssemblyActivities:

e. EcumenicalActivity:

f. SpecialInterests,Hobbies:

g. Languagesyoucanspeak(andlevelofproficiency):

h. Typesofsupervision/accountabilityyouhavefoundhelpfulinyourministry:


Name:

Part3:Narrative

1. LifeStory:Inonepage,describeyourlife’sjourney.Includekeyincidentsthatweresignificantinyourformationasapersonandyourcalltoministry.Stateyourpersonalidealsandgoals.


Name:

2. Pleasedescribebriefly(confineyouranswerstospaceallotted):

a. Myleadershipstyle:(Howyouincludeothersindecision-making,administrativestyle,waysyoudealwithconflict,etc.?)

b. Myworshipemphases:(preachingstyle,preferredworshipemphasesandstyle,etc.)

c. Mycalltoministry:(Whattypeofministryroleareyoucalledto?Whatwouldeffectivenesslooklikeinthatrole?)


Name:

3. Commentbrieflyonyourviewsasrelatesto:a. Spiritualgiftedness

b. Charismaticexpressioninworship(manifestationofspiritualgifts)

c. Womeninordainedoffice

d. Presbyterianconnectionalsystem

4. DoyouagreewiththesystemofgovernmentoftheEvangelicalPresbyterianChurch?

cYes cNo(pleaseexplainbriefly):

5. DoyousincerelyreceiveandadopttheWestminsterConfessionofFaithandCatechismsofthisChurchascontainingthesystemofdoctrinetaughtintheHolyScriptures?

cYes cNo(pleaseexplainaspartofyouranswerto#6below)


Name:

6. DoyoutakeanyexceptionstotheWestminsterConfessionofFaithandCatechisms?

cYes cNo

Ifyes,pleaseidentifythetopicwiththespecificchapter,paragraph,orquestionnumberwithwhichyoutakeyourexception.(Note:youwillneedtosubmitawrittenstatementoftheseexceptionstotheMinisterialCommitteeandpresbyteryduringtheexaminationprocess.)

7. DoyouwillinglyofferthesacramentofinfantbaptismtoChristianparents?

cYes cNo(pleaseexplainbriefly):


Name:

Part4:MinistryPreferencesandHistory(checkallthatapply)

SizeofChurch WouldServe HaveServedUpto150members c c

150to300members c c

300to500members c c

500to1,000members c c

Over1,000members c c

PositionTypePastor(Solo) c c

Pastor(HeadofStaff) c c

StaffMinistryAssociate c c

Assistant c c

CongregationalCare c c

Education c c

Outreach c c

Youth c c

Other: c c

Chaplaincy c c

ChurchPlanting c c

Tentmaking c c

TemporaryOccasionalSupply c c

StatedSupply c c

InterimSupply c c

WorldMissions c c

HomeMissions c c

Other: c c

CommunityTypeRural(Country/Farming) c c

Suburban c c

Town/Village c c

Urban(Metropolitan) c c

Urban(InnerCity) c c

College/University c c

Multi-Cultural c c

Ethnic(Specify: ) c c

GeographicAreasU.S.West c c

U.S.Midwest c c

U.S.South c c

U.S.East c c

U.S.MiddleAtlantic c c

U.S.Southeast c c

Other: c c


Name:

Part5:Appraisal 1. Self-Appraisal:Whatfivekeycharacteristics/gifts/skillswouldyoubringtoaministryposition?

2. References:ChoosefiveindividualstocompletethewrittenreferenceformattheendofthisdocumentandwhoarewillingtobecontactedbyphonebyaSearchCommitteeandaPresbyteryMinisterialCommittee.Ifpossible,oneofthesereferencesshouldrepresentyourcurrent/lastcongregationSession.Whenprovidingtheformtoyourreferences,includeastampedenvelopeaddressedtotheEPCOfficeoftheGeneralAssembly(addressprovidedonpage1).

1. Name:____________________________________________________________________________________________________

Address:_________________________________________________________________________________________________

E-mail: ____________________________________________________Preferredphone:__________________________

Person’srelationshiptoyou:__________________________________________________________________________

2. Name:____________________________________________________________________________________________________

Address:_________________________________________________________________________________________________



3. Name:____________________________________________________________________________________________________

Address:_________________________________________________________________________________________________



4. Name:____________________________________________________________________________________________________

Address:_________________________________________________________________________________________________



5. Name:____________________________________________________________________________________________________

Address:_________________________________________________________________________________________________




Name:

Part6:BackgroundDisclosure

Tothepersoncompletingthesestatements:

CongruentwiththeconcernforethicalperformanceofministryintheEvangelicalPresbyterianChurchandopennessaboutissuesthataresensitivetofunctioninginthepublicroleofapastorinacongregation,youareaskedtorespondtothefollowingstatements.Thereisopportunityforexplanationifyousodesire.

TotheSearchCommitteeorSessionofacallingchurch:

Anypracticeofroutinelyrejectingprofilesonaperfunctorybasiswithoutacompleteandthoughtfulreviewoftheexplanationsofferedbythecandidateisstronglydiscouraged.Theinformationpresentedhereismeanttoprovideanoccasionforopen,honestdialogue.

Thisdisclosurestatementwillonlybesharedwithaninterestedcongregationaspartofthesecondphaseofthesearchprocess.

1A. HaveyoueverbeenthesubjectofofficialdisciplinebyaSessionorPresbyteryoftheEvangelicalPresbyterianChurch?

Suspended cYes cNo

Deposed cYes cNo

1B. Isanyofficialdisciplinaryactioncurrentlypending?

cYes cNo

1C. Haveyoueverbeenthesubjectofofficialdisciplinaryproceedingsbyanotherdenominationthatresultedindisciplinaryaction?

cYes cNo

1D. Areanyofficialdisciplinaryproceedingsbyanotherdenominationcurrentlypending?

cYes cNo

Explanationof1A–1D:


Name:

2A: Hasacivillawsuit,criminalcharge,orofficialecclesiasticalcomplaintbeensustainedagainstyouforsexualdiscrimination,harassment,exploitationormisconduct,physicalabuse,childabuse,orfinancialmisconduct?

cYes cNo

2B. Haveyoueverbeenconvictedofafelony?

cYes cNo

Explanationof2A–2B:

3A. Hasyouremploymenteverbeenchangedbecauseyouattemptedoractuallyengagedin:

A. SexualDiscrimination,Harassment,Exploitation,orMisconduct cYes cNo

B. PhysicalAbuse cYes cNo

C. ChildAbuse cYes cNo

D. FinancialMisconduct cYes cNo

3B. Hasyouremploymenteverbeenchangedinordertoavoidfacingortoavoidbeingterminatedbecauseofchargesofactualorattempted:

A. SexualDiscrimination,Harassment,Exploitation,orMisconduct cYes cNo

B. PhysicalAbuse cYes cNo

C. ChildAbuse cYes cNo

D. FinancialMisconduct cYes cNo

Explanationof3A–3B:

Irecognizethatpresbyteriesarerequiredtoperformabackgroundinvestigationonallindividualsseekingcandidacyormembership.Ifurtherrecognizemyresponsibilitytoupdatethisbackgrounddisclosureinatimelymannershouldtherebeachangeofstatusinanyoftheissuesnamedabove.

Signature: Date:

Typeorprintyourname:

Referencefor Youhavereceivedthisreferenceformfromapersonwhovaluesyouropinion.Thematerialyouprovidewillbeplacedwithothermaterialstocomprisetheindividual’sPersonalInformationFormforuseintheEvangelicalPresbyterianChurch.TheOfficeoftheStatedClerkencouragespersonstoupdateregularlyorprepareanewPersonalInformationForm.Therefore,beingaskedtoprovideareferencedoesnotnecessarilyimplythatthepersonisinterestedinachangeinposition.Committeesmayusethematerialyouprovideinthefutureifthepersonseeksachange.Youarebeingaskedtoprovideasclearapictureofthispersonaspossiblethroughtheattachedreferenceformwhichincludesanopportunitytocomment.Indicatethequalitiesevidencedinthisperson’sministryatthistimeasyouhaveencounteredthem.Bearinmindthatothercongregationsand/orministriesrelyonthecompletenessandaccuracyoftheinformationthatyouprovide.Foryourinformation,thepersonforwhomyouarecompletingthisreferenceformhassignedthefollowingstatementofconsent,whichisonfileattheOfficeoftheGeneralAssembly:Iauthorizethepersonsandentities,suchasmembersofsearchcommitteesofaprospectivecallingbodyorappropriatestaffpersons,tomakeinquiriesregardingallstatementscontainedinmyPersonalInformationForm.IalsoauthorizeallpersonsreferredtointheProfileasreferences,membersofcongregationsIhaveserved,orpersonal/professionalcolleaguestosupplyverificationoftheinformationprovidedinthePersonalInformationForm.Iunderstandthatsuchpersonsmaycommentonandstatetheiropinionsregardingallmattersaddressedintheprofileincluding,withoutlimitation,mybackgroundandcharacter.Toencouragesuchpersonstospeakopenlyandresponsibly,Iherebyreleasethemfromanyclaimsorliabilitiesarisingfromtheirresponsesandcommentsifmadeingoodfaithandwithoutmalice.Ifyouneedadditionalspacetoansweranyquestions,pleaseattachedaseparatesheet(andensurethatthequestionnumberisincluded).SendcompletedReferenceFormto:

OfficeoftheStatedClerkEvangelicalPresbyterianChurch5850T.G.LeeBlvd.,Suite510

Orlando,[email protected].

Ifthepersonaskingforthisreferenceprovidedtheformtoyouasahardcopy,theyshouldhavealsosuppliedastampedenvelopewiththisaddressforyouruse.

EPCPIFReferenceForm FormUpdatedFebruary2018 2

Referencefor Date Pleaseanswerasmanyofthefollowingquestionsasyouareable.Ifyouhavenoknowledgeoropiniononanyofthequestions,pleasecheck“unknown.”1. Inwhatcapacityandhowlonghaveyouknownthecandidate?2. Incomparisonwithotherministersyouhaveknown,indicate:(1)SeriousDeficiency (2)BelowAverage (3)Average

(4)AboveAverage (5)Exceptional (6)Unknown

1 2 3 4 5 6Preachingability c c c c c cWorshipleadership c c c c c cTeachingability c c c c c c

Engagesinandfostersevangelism c c c c c cEngagesinandfostersdiscipleship c c c c c cAbilitytoencourageotherstodeveloptheirgifts c c c c c cEarnsloyaltyofcolleaguesandothers c c c c c cCapacitytoobjectivelyevaluateownstrengthsandweaknesses c c c c c cPhysicalhealth c c c c c cMentalandemotionalhealth c c c c c c

1 2 3 4 5 6

3. Ishe/sheabletosuccessfullyworkwithothers?

EPCPIFReferenceForm FormUpdatedFebruary20183

Referencefor

Date

4. Doeshe/sheshowevidenceofalcoholorothersubstanceabuse?Ifso,pleaseexplain.

5. Howdoeshe/shehandleangerorfrustration?

6. Doeshe/shehaveanypersonalqualitiesthatmighthamperministryeffectiveness?

7. Wouldyourecommendhim/herasaminister?

8. Pleasestateyourreservationsifyouareunabletorecommendhim/herasaminister.

9. Additionalcomments:

Signature:

PrintName:

Address:

Email:

PreferredPhone:

name: date - epc.org · epc personal information form 1 form updated february 2018 name: date: the...

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