Name (Last, First, Middle):______________________________________________________________

Current Street Address or P.O. Box: ______________________________________________________

City, State and Zip/Postal:_______________________________________________________________

Country:_________________________________ Valid until: __________________________

Permanent Address: _______________________________________________________________________________

^{(if different from above)} __________________________________________________________________

I wish to be considered for: (check all that apply)

Personal Information

Gender: Male � Female � Citizenship:___________________ Passport No.___________________

Social Security Number (If applicable): _____________________________

Green Card Number (If applicable): _____________________________

Residency Card (If applicable): _________________ Valid until/Status? ______________________

Date of Birth: (mm/dd/yr)_________ Place of Birth: __________________________________

Present Occupation: _______________________________________________________________

Nationality: _____________________________

Optional: Ethnic Identity: _________________ Racial Identity_____________

Marital Status: Single � Married � Divorced �

If Married, date of marriage: (mm/dd/yr) _______________________

Spouse's Name: ______________________ Spouse's Birth Date: ______________________ mm/dd/yr

Spouse's Occupation: ___________________________________

Is spouse also applying for missionary service? Yes � No �

If Divorced, Date of divorce: (mm/dd/yr)____________Divorce Pending?:____________

Children: (If child is adopted, please give legal status of documentation)

Name	Gender	Date of Birth	Will child accompany you? (Yes/No)
1.	-	-	-
2.	-	-	-
3.	-	-	-
4.	-	-	-

In Case of Emergency

Contact Person/Next of Kin:

Name: _________________________________________ Relationship: ________________________

Address: _______________________________________ Phone: _____________________________

_______________________________________

Church Identification

Local Church: ________________________________________________________

Member since what year? _____________

Pastor: _________________________________________________________

Address: _________________________________________________________

City, State, Zip: _________________________________________________________

Phone Number: _________________________________________________________

Ordained?

Deacon � Date of Ordination: (mm/dd/yr)_________
Elder � Date of Ordination: (mm/dd/yr)______

Are you preparing for Ordination? Yes � No � Anticipated Date: (mm/dd/yr)__________

Consecrated?

Diaconal Minister � Date of Consecration: (mm/dd/yr)__________

Other � Date of Consecration: (mm/dd/yr)__________

Commissioned?

Deaconess � Other � Date of Commissioning: (mm/dd/yr)__________

If United Methodist

Since what year? _________

Annual Conference:__________________________________________________

Current Pastor: _____________________________________________________

Address: __________________________________________________________

Current District Superintendent: ________________________________________

Phone Numbers: Pastor:_________________________ Dist. Supt.: ___________________________

Position Requested

Placement(s) for which you wish to be considered:

Country	Position
-	-
-	-

Are you willing to be considered for other types of placements? Yes � No �

If yes, please specify: __________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

In other countries? Please specify: ______________________________________________________________

Availability Date: __________________________ For how long? __________________________

WORK EXPERIENCE:

EDUCATION

Present Or Anticipated Qualification Or Certification(s): (Attach Copies Of Certificates)

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

For Teachers: Certification for grade level(s) and/or subjects: (Attach Copies Of Certification)

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

LANGUAGE ABILITIES:

Language: (What languages do you know? Please include English)

1.	Read �	Converse �	Speak �	Write �	Native �	Lecture/Preach �
2.	Read �	Converse �	Speak �	Write �	Native �	Lecture/Preach �
3.	Read �	Converse �	Speak �	Write �	Native �	Lecture/Preach �
4.	Read �	Converse �	Speak �	Write �	Native �	Lecture/Preach �

Complementary Information:

What other information may be helpful to share as we explore the possibilities of Mission Service? (e.g., salary needs, responsibilities, family attitudes, personal philosophy, timing, etc.) You may use the back side of this page. ATTACH an extra type written sheet if necessary.

EXPERIENCE AND VOCATION TO CHRISTIAN MISSION

(Using additional sheets of paper, please respond to each of the following questions in one concise paragraph. Number each question accordingly. Print your name on the upper left hand corner of EACH page.)

1. CHRISTIAN EXPERIENCE:

1.a In what ways do you experience the presence of God in your life? Describe the discipline you follow in your prayer life.
1.b What do you believe about the Bible?
1.c Describe ways in which you have been able to share your faith with others and lead them to believe in Jesus .

2. UNDERSTANDING OF MISSION

2.a How do you understand the nature and mission of the Church? What influences have helped shape your understanding? How have you been involved in the mission of the Church?
2.b What factors have drawn you to pursue a vocation in mission service? Which factors have been most important?

3. INTER-CULTURAL, INTER-ETHNIC AND INTERRACIAL EXPERIENCE AND UNDERSTANDING:

3.a Describe your experience with and understanding of racism..
3.b What relationships do you have with persons of a different race, culture, and/or economic class?
3.c Describe your experience with and understanding of sexism..
3.d Will you willingly submit to the authority of the leadership of the church in your place of assignment? Please comment.
3.e If required, will you apply yourself to learning another language to acquire a working knowledge of it? Please comment.

4. PERSONAL RELATIONSHIPS AND INTERPERSONAL SKILLS:

4.a How have you prepared for participation in mission service?
4.b Why do you believe God is leading you to mission service?
4.c Describe your strengths.
4.d Describe your weaknesses.
4.e What has been your experience of your working relationship with supervisors.

5. PROFESSIONAL COMPETENCE AND EDUCATIONAL PREPARATION:

5.a Where do you believe you are called to serve, and in what capacity?
5.b What continuing education activities have you participated in during the past three years?
5.c List some titles and authors of books you have read in the past year.
5.d List newspapers and periodicals that you read regularly.
5.e Which historical person do you most admire? Why?

6. PHYSICAL AND EMOTIONAL HEALTH:

6.a What illnesses have you had in the past year? What treatment or medication did you use?
6.b What illnesses have accompanying family members had in the past year? Treatment or medication used by accompanying family members?
6.c Have you or any member of your immediate family ever been under the care of a psychiatrist? Please explain.

7. CHRISTIAN FAMILY LIFE:

7.a If you are married, does your spouse have a commitment to mission service? Please comment.
7.b How thoroughly have you discussed mission service with your family? Please comment.
7.c If you have children, how have you and your spouse prepared your children for possible mission service?
7.d If you are married, are your spouse and your accompanying children willing to become part of the local community where all of you would serve?
7.e Are you and your accompanying family willing to regularly attend and participate in worship of the local community in which you serve?

1. Grade yourself on the following skills. Note professional experience and certification below.

(Use the following scale of 0 to 5)

0 = None
1 = Awareness
2 = Limited Experience
3 = Some Experience-No Credentials
4 = Much Experience-Somewhat Effective-No Credentials
5 = Experience-Very Effective-Credentials

2. Skills and professional experience for which you believe you are best suited. (Specify area and certification)

3. What skills and special talents do you offer to mission service?

4. What tasks do you find most challenging?

5. What tasks will you not perform?

6. How do you work best? Alone?_____ In teams?_____

What has been your experience?

7. In what areas have you taught or trained others?

8. What are your hobbies? (Sports, crafts, etc.)

9. What do you do for relaxation?

REFERENCES

Please list below the names, addresses, and phone numbers of not less than five persons who are qualified to provide further information about you. Select as diverse a group of persons as possible with regard to race, gender, age, etc.

To each person listed as a reference, send a copy of the Confidential Reference Form along with the envelope provided. Make sure that the envelope is addressed to yourself.

Each person must complete the form confidentially. Request each reference person to enclose their completed form in the envelope provided. Have them seal the envelope, affix their signature over the sealed flap, and mail it back to you. When you receive the envelopes do not open them.

Place the sealed envelopes with your completed Personnel Information Form, along with your transcripts in a large envelope. When all references and transcripts have been received (see instructions) mail the completed packet of materials directly to:

Chairperson (of your)
Conference Committee on Mission Personnel

-or-

General Board of Global Ministries
Mission Personnel
475 Riverside Drive - Room 320
New York, NY 10115, U.S.A.

1.________________________________________________________________________________
^{(Laity: Your current or former Pastor. Pastors: Your District Superintendent. Clergy Family: use non-relative)}

2.__________________________________________________________________________________
^{(Teacher Or Instructor In College, Seminary, Graduate School Or Any Other Learning Experience)}

3.__________________________________________________________________________________
^{(Colleague In a Learning Experience)}

4.__________________________________________________________________________________
^{(Employer, Supervisor Or Another Person Who Knows Your Work, i.e. Student, Employee, Parishioner, etc., In A Significant Work Experience, Including Volunteer/Community Work)}

5.__________________________________________________________________________________
^{(Professional Associate Or Co-Worker)}

6.__________________________________________________________________________________
^{(Good Friend)}

Write a clear and direct story of your life. Be sure to include the persons and events which you believe to have been of greatest signficance of your devlopmet. (Please limit your statement to no more than 2 typewritten pages.)

I certify that I have personally prepared this Personnel Information Form and that the information I have provided is true to the best of my knowledge.

Signature:________________________________________ Date:____________________

| Personnel Information Form Instructions | Mission Opportunities | GBGM | GBGM Employment |