Application for Pastoral Appointment online

APPLICATION FOR PASTORAL APPOINTMENT

Daktoas Conference of the United Methodist Church

Please contact the Conference office c/o cabinet assistant Bea Stucke (bea.stucke@dakotasumc.org) for any questions.

The asterix at the end of a question indicates that it is required to answer and necessary to successfully submit this form.

DEMOGRAPHIC INFORMATION

Name *

Email *

Address (street, city, state, zip code) *

Telephone (work, home) *

Date of Birth (month/day/year) *

Social Security Number (this item would be very helpful but we understand that we cannot mandate you to provide it)

Marital status *

Single

Married

Divorced

Children (names and ages)

Spouse's name and date of birth

If not a US Citizen, do you have proof you can be employed in the U.S. ?

Yes

If yes, please state your documentation

APPLICATION INFORMATION

Applying for *

Full Time

Less Than Full Time

Present Cash Salary in US $

Itemize other present benefits

Salary required if appointed in US $ (cash salary plus list any other benefits required) *

Do you have financial obligations (debts, child support, garnishments, etc.) that require special consideration? *

When could you start? *

Are there limitations on appointment and/or location? *

Please list current credentials now held for ordained ministry: *

Which denomination or Conference? *

If changing denomination or conference, what is our reason? *

Can you verify your appointment status, i.e., that your are, in fact, appointable? *

yes

How? (Please list below references to and also email pages of the Journal/ Yearbook of your Annual Conference or Judiciatory) *

If you are a United Methodist, what is our current relationship to the Annual Conference? (e.g., Effective, Leave of Absence, etc.) *

Any restrictions to your credentials? (Identiry) *

Theological Seminary and Degree *

Undergraduate School and Degree *

Ministerial Service Record - please list all positions and the reason for leaving *

BACKGROUND INFORMATION

Have your credentials ever been reviewed or suspended for any reason? *

Yes

If yes, then state the reason

Have you ever been accused of sexual misconduct? *

Yes

If yes, please explain

Have you ever been arrested or convicted of any misdemeanor or crime? *

Yes

If yes, please explain

Are you willing to submit to a comprehensive background check *

Yes

Do you presently hold a valid driver's license? *

Yes

If no, please explain

List any physical or emotional or mental impairments which may interfere with your ability to do ministry. This information will not be used in any manner which has the effect of discriminating against qualified handicapped individuals. *

Please make any comments you feel pertinent to you application.

"For the sake of the mission of Jesus Christ in the world and the most effective witness to the Christian gospel and in consideration of your influence as an ordained minister, are you willing to make a complete dedication of yourself to the highest ideals of the Christian life; and to this end will you agree to exercise responsible self-control by personal habits conducive to physical health, intentional intellectual development, fidelity in marriage and celibacy in singleness, integrity in all personal relationships, social responsibility, and growth in grace and the knowledge and love of God?" (The Book of Discipline, Par. 335a)(6)

Yes

REFERENCES

(The listing of references implies consent to contact unless otherwise noted.)

District Superintendent (or supervising person) - Please list name, phone number, address.

Bishop (or judicatory head) - Please list name, phone number, address.

Colleague Pastor - Please list name, phone number, address.

Lay Person - Please list name, phone number, address.

I hereby certify that the information contained in this application form is true and correct and I authorize contact of any of my schools, former employers, or other references unless otherwise stated. This is to be done for the purpose of collecting information and an account of their experiences with me. I agree to hold any or all of them blameless and free of any liability for releasing any truthful information that is within their knowledge or records. I understand that if I am appointed, any misrepresentation of the facts as stated or implied on this application formis sufficient cause for dismissal. I also understand that I may be required to successfully complete a medical examination and/or psychological exam before appointment. This agreement does not bind either party for any specific period regarding employment. *

Yes

Application for Pastoral Appointment online

DEMOGRAPHIC INFORMATION

APPLICATION INFORMATION

BACKGROUND INFORMATION

REFERENCES

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