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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)
www.epc.org
EPCPersonalInformationForm FormUpdatedFebruary20182
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:
EPCPersonalInformationForm FormUpdatedFebruary20183
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
EPCPersonalInformationForm FormUpdatedFebruary20184
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:
EPCPersonalInformationForm FormUpdatedFebruary20185
Name:
d. PresbyteryandGeneralAssemblyActivities:
e. EcumenicalActivity:
f. SpecialInterests,Hobbies:
g. Languagesyoucanspeak(andlevelofproficiency):
h. Typesofsupervision/accountabilityyouhavefoundhelpfulinyourministry:
EPCPersonalInformationForm FormUpdatedFebruary20186
Name:
Part3:Narrative
1. LifeStory:Inonepage,describeyourlife’sjourney.Includekeyincidentsthatweresignificantinyourformationasapersonandyourcalltoministry.Stateyourpersonalidealsandgoals.
EPCPersonalInformationForm FormUpdatedFebruary20187
Name:
2. Pleasedescribebriefly(confineyouranswerstospaceallotted):
a. Myleadershipstyle:(Howyouincludeothersindecision-making,administrativestyle,waysyoudealwithconflict,etc.?)
b. Myworshipemphases:(preachingstyle,preferredworshipemphasesandstyle,etc.)
c. Mycalltoministry:(Whattypeofministryroleareyoucalledto?Whatwouldeffectivenesslooklikeinthatrole?)
EPCPersonalInformationForm FormUpdatedFebruary20188
Name:
3. Commentbrieflyonyourviewsasrelatesto:a. Spiritualgiftedness
b. Charismaticexpressioninworship(manifestationofspiritualgifts)
c. Womeninordainedoffice
d. Presbyterianconnectionalsystem
4. DoyouagreewiththesystemofgovernmentoftheEvangelicalPresbyterianChurch?
cYes cNo(pleaseexplainbriefly):
5. DoyousincerelyreceiveandadopttheWestminsterConfessionofFaithandCatechismsofthisChurchascontainingthesystemofdoctrinetaughtintheHolyScriptures?
cYes cNo(pleaseexplainaspartofyouranswerto#6below)
EPCPersonalInformationForm FormUpdatedFebruary20189
Name:
6. DoyoutakeanyexceptionstotheWestminsterConfessionofFaithandCatechisms?
cYes cNo
Ifyes,pleaseidentifythetopicwiththespecificchapter,paragraph,orquestionnumberwithwhichyoutakeyourexception.(Note:youwillneedtosubmitawrittenstatementoftheseexceptionstotheMinisterialCommitteeandpresbyteryduringtheexaminationprocess.)
7. DoyouwillinglyofferthesacramentofinfantbaptismtoChristianparents?
cYes cNo(pleaseexplainbriefly):
EPCPersonalInformationForm FormUpdatedFebruary201810
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
EPCPersonalInformationForm FormUpdatedFebruary201811
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:_________________________________________________________________________________________________
E-mail: ____________________________________________________Preferredphone:__________________________
Person’srelationshiptoyou:__________________________________________________________________________
3. Name:____________________________________________________________________________________________________
Address:_________________________________________________________________________________________________
E-mail: ____________________________________________________Preferredphone:__________________________
Person’srelationshiptoyou:__________________________________________________________________________
4. Name:____________________________________________________________________________________________________
Address:_________________________________________________________________________________________________
E-mail: ____________________________________________________Preferredphone:__________________________
Person’srelationshiptoyou:__________________________________________________________________________
5. Name:____________________________________________________________________________________________________
Address:_________________________________________________________________________________________________
E-mail: ____________________________________________________Preferredphone:__________________________
Person’srelationshiptoyou:__________________________________________________________________________
EPCPersonalInformationForm FormUpdatedFebruary201812
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:
EPCPersonalInformationForm FormUpdatedFebruary201813
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: