Seventh-day Adventist Church
|[pic] |PERSONAL INFORMATION |
| |(Application Form) |
| |Interdivision Employee |
|This request for information does not constitute a call nor should it cause you to interrupt in any way your present activities or current employment. If |
|a call is voted, it will be communicated to you by an official letter. If you are denominationally employed, the letter will be sent through your |
|employing organization. |
|DATE: |
|BIOGRAPHICAL INFORMATION (Please type or use black ink.) |
|Appointee |*Spouse |
|Last/Family Name (Legal Name) |Last/Family Name (Legal Name) |
| | |
|First/Given Name (including Middle/Maiden) |First/Given Name (including Middle/Maiden) |
| | |
|* Because you and your spouse will be considered for mission service as a team, please indicate his/her name with the appropriate Information above AND |
|both you and your spouse will need to complete separate Personal Information forms. |
|Regular/Permanent Address: |Current Address (If different from permanent address): |
|As of This Date: |Until This Date: |As of This Date: |Until This Date: |
|(Month/Day Year) |(Month/Day/Year) |(Month/Day/Year) |(Month/Day/Year) |
| | | | |
|Address Line 1: | |Address Line 1: | |
|Address Line 2: | |Address Line 2: | |
|City: | |City: | |
|State/Province: | |State/Province: | |
|Postal Code: | |Postal Code: | |
|Country/Region: | |Country/Region: | |
| |
|Current Contact Numbers—Please include country, city and area codes, if applicable: |
|Home Phone: | |Work Phone: | |
|E-Mail Address: | |Fax: | |
| | | | |
|How did you become a Seventh-day Adventist? |
| |
|Date or year of baptism: |Local church where you currently hold membership: |
| | |
|Have you been denominationally employed? Yes If Yes, total years denominationally employed: |
|No |
|Are you an ordained minister? Yes If Yes, Indicate date of ordination (Month/Day/Year): |
|No |
|What denominational | Missionary License |Where? |
|credential/license do you |Missionary Credentials | |
|hold? |Ministerial License | |
| |Ministerial Credentials | |
| | |Conference/location (Issuing organization): |
| | | |
S—312
7.09 FOR GC USE ONLY: Copy to Office of Interdivision Personnel Records
|EDUCATIONAL RECORD |
|Level |Name(s) of School(s) |Location |Date(s) |Check Last |Course of Study |Did you |Diploma or Degree |
| | |(City/State/Country) |Attended |Year Completed| |Graduate? |Conferred |
| | | |From/To | | |(Yes/No) | |
|Secondary | | | | | | | |
| | | | |1 |2 |3 |4 |
|Graduate or | | | |Hours Compl: |Major Field/ Specialty:| |Degree: |
|Professional | | | | | | |Date: |
|HOURS OF UNDERGRADUATE COLLEGE WORK IN (Listing is optional if graduate degree obtained): |
| Agriculture | Biology | English | Mathematics | Physics |
| Art | Business Administration | Health | Modern Language | Religion |
| Behavioral Science | Chemistry | History | Music | Secretarial Science |
| Bible | Education | Industrial Arts | Nursing | Speech |
| Biblical Language | Engineering | Library Science | Physical Education | |
|If graduate work is unfinished, where do you plan to complete it? |When? (Month/Day/Year) : |
| | |
|LANGUAGE PROFICIENCY |
|Language |Fluency (P = Poor, A = Average, F = Fluent) |
|Mother/Native | |Speak | |Read | |Write | | |
|2nd Language | |Speak | |Read | |Write | | |
|3rd Language | |Speak | |Read | |Write | | |
|4th Language | |Speak | |Read | |Write | | |
|PHYSICIAN, DENTIST, AND HEALTH APPLICANTS ONLY |
|Specialized/postgraduate training (Dates and Field of Study): |Degrees or boards acquired: |State/country where you are licensed: |
| | | |
|Begin: |End: |Field: | | |
|Begin: |End: |Field: | | |
|Begin: |End: |Field: | | |
|TEACHERS, PROFESSORS, AND EDUCATION PROFESSIONAL APPLICANTS ONLY |
|Specialized/postgraduate training (Dates and Field of Study): |Teaching certification acquired: |Cert. Type: |State/country where cert.: |
|Begin: |End: |Field: | | | |
|Begin: |End: |Field: | | | |
|Begin: |End: |Field: | | | |
|EXPERIENCE |
|(List most recent work experience first. The full address—Street, City, State/Province, Postal Code—is required for the current employer only.) |
|Positions or Type of Work |Employing Organization |Dates of Service |Total |Total Years |
|(Including nonstudent denominational and | |(Month/Day/Year) |Years |in Related |
|nondenominational employment) | | | |Field |
| | |From |To | | |
|Current: | | | | | |
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|EXPERIENCE, contd. |
|Do you have a current pilot's license? Yes No |
|Work experience while a student: |
| |
|Positions held or significant activities while a student: |
| |
|In addition to the preceding, what experience have you had in youth and Sabbath school leadership, etc? |
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|What special skills or abilities do you have? |
| |
|What are your hobbies or special interests? |
| |
|What musical training do you have? |What musical instruments do you play? |
| | |
|MILITARY SERVICE | |
|Country: |Begin Date: |End Date: |Branch: |
|Are you currently a member of any military reserve component with an obligation subject to mobilization or recall? Yes No |
|If yes, until what date? |
|HEALTH | |
|As a prerequisite to consideration for employment, the applicant must agree to submit to any pre-employment examinations, physical or other, as the General|
|Conference may lawfully require. |
|SERVICE INTEREST | |
|State briefly the basis or source of your interest. (How did you learn about overseas mission service–recruitment, publication, etc?) |
| |
|When would you be available to begin work if an offer is made? Date: |
|In what line of work do you prefer to engage (check no more than three (3) of the following areas of interest)? |
| Medical (e.g. Physician or Dentist) | Educational (e.g. English Language Teacher or Professor) |
| Administrative/Support Staff (e.g. Accountant, Secretary) | Special Skills (Construction, Agricultural, Computer) |
| Frontline or Pioneer (e.g. New Territories) | Pastoral or Evangelistic (e.g. Senior/Youth Pastor) |
| Adventist Development & Relief Agency-ADRA | Other |
|What profession do you consider yourself best qualified (list in order of skills/abilities–with your best qualifications listed first)? |
|1st | |3rd | | |
|2nd | |4th | | |
|What areas/countries would you prefer to serve (list in order of preference)? |
|1st | |3rd | | |
|2nd | |4th | | |
|Would you have any difficulty adapting to a different environment if you accepted an overseas assignment? If yes, please explain: |
| |
|Do you have any reservations about working under the direction of leaders of a race or nationality other than your own? If yes, please explain: |
| |
|MISSION COMMITMENT |
|Please write a paragraph between 50-250 words about your commitment to mission service, why do you wish to give mission service? |
| |
|Please write a paragraph between 50-250 words about your personal experience in witnessing to others about Christ. |
| |
|REFERENCES |
|Give Names and Addresses of Individuals in the Following Categories Who Are Well Acquainted With You (Include person of a culture other than your own if |
|possible): |
|CATEGORY |NAME |FULL ADDRESS |
| | |(Street, City, State/Province, Postal Code) |
|*Present employer and | | Phone Number: |
|supervisor | | |
|One conference president or | | Phone Number: |
|institutional administrator | | |
|Four denominational employees| | Phone Number: |
| | | |
|Church pastor/church officer | | Phone Number: |
|acquainted with you | | |
|**Two of your teachers or | | Phone Number: |
|professors | | |
|***Three professional |1st | | Phone Number: |
|contemporaries with | | | |
|whom you have worked | | | |
|within the last three | | | |
|years | | | |
| |2nd | | Phone Number: |
| | | | |
| |3rd | | Phone Number: |
| | | | |
|*Check the box if you prefer not to have your present Employer or Supervisor contacted. |
|**If you have been out of school for five years or more, two names other than teachers may be given. |
|***For medical/dental professionals only. |
|REMARKS |
|On a separate sheet of paper, please provide any additional information you would like the employer to consider in evaluating your application for mission |
|service. |
| | |
|Signature |Date |
|WHEN COMPLETED, MAIL TO: SECRETARIAT |
|GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS |
|12501 OLD COLUMBIA PIKE |
|SILVER SPRING, MD 20904-6600 |
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