Basic Data

Alternate address of a person who can always reach you:

Are you a US Citizen?


If no, do you have the legal right to retain employment in the US?

Availability and Program

Desired length of service ( ✓✓ double check first preference; ✓ single check all other possibilities)

What issues/factors could affect:



Program preference (refer to descriptions in cover letter)

✓✓Double check first preference

✓ Single check all other possibilities


Assignment-Check appropriate boxes

TYPES OF MISSION SERVICE for which you believe you can do well in an international context:
(check all that apply):


Church Membership



Volunteer Service

SCHOOL NAME AND LOCATION Course or Major No. of Years Degree and Date
Employment History
Begin with current or most recent employer. Include those posiions for which you worked more than 20 hours per week.

May we contact your current or most recent employer at this time?

Occupation and Skills
Marital Status
If you are married, does your spouse plan to accompany you?

Couples Please Note: Each adult intending to live in the assigned country needs to fill out a separate
Mission Personnel Information form, whether or not he/she seeks a mission assignment.
Provide information about your dependents. Place a "✓" by those who will accompany you to the country of service.
Full Name Date of Birth Citizenship

Placement and Match-making

Placement may be influenced by such factors as finances, housing, educational needs of children or other family or personal issues
Financial considerations: Do you have particular financial considerations that might influence the type and
length of assignment you could accept?

Life situations: Service in international settings may present challenges related to health, environment,
climate and security among others. These issues may affect a person's ability to live and work in a
particular setting.
Indicate below any concerns you have related to the following:

Children's education (if applicable): If you have or expect to have school age children your term of service,
are you open to: (check all that apply)



Passport Information
A passport is necessary for international service. If you currently have a passport, indicate below:
Legal consideration

Sexual Misconduct Policy Certification:


(a) Has any civil, criminal, or ecclesiastical complaint ever been sustained or brought against you for
sexual misconduct?

(b) Have you ever resigned or been terminated from a position for reasons related to sexual misconduct?

Prior or Pending Offenses:

(a) Have you ever been convicted of, pled guilty to or pleaded "no contest" to any crime, other than minor
Traffic violations?

(b) Are any charges (for any offense, including traffic offenses), civil suits, or judgments outstanding
against you?

Provide four names, including, pastor, professional/academic, employer
Print names and information neatly and clearly
Additional Information
How did you learn about global mission opportunities with the Episcopal Church? Check all that apply.
NOTE: You need to notify your bishop that you are in conversation with Mission Personnel.

1. All information provided on this Mission Personnel information form is complete and accurate, to the
best of my knowledge.
2. Candidates who serve with the Episcopal Church Mission Personnel Office will be expected to
understand, respect, and support the mission of the Episcopal Church Center.
3. Misrepresentation of facts in this Mission Personnel Information form will disqualify me from further
consideration or, if! serve with the Episcopal Church Mission Personnel Office, may be sufficient
cause for dismissal.
4. In compliance with Federal laws, all offers of employment are subject to verification of each
applicant's identity and employment authorization. I understand that it will be necessary for me to
submit such documents as are required by law to verify my identification and employment
5. Any position offered to me is contingent upon the satisfactory completion of reference checks and any
other checks, testing or examinations as may be requested by the Episcopal ChurchlMission Personnel
6. I understand that nothing contained in this form, or in the granting of an interview is intended to create
a contract between the Episcopal ChurchlMission Personnel and me, either for employment or for
providing of any benefits. No promises regarding employment have been made to me, and I
understand that no such promises or guarantee is binding upon the Episcopal ChurchlMission
Personnel unless made in writing.
7. The Episcopal ChurchlMission Personnel has my permission to investigate, at its discretion, my past
employment history, personal references, and any other information contained in this Mission
Personnel Information form.
8. I fully agree to the statements and conditions listed 1 through 7 above.

Use the checklist below to ensure your Mission Personnel Information form package is complete:



Send completed Mission Personnel Information
form, narrative and resume to:
Mission Personnel, 6FL
The Episcopal Church Center
815 Second Ave
New York NY 10017-4561
Questions related to completing the Mission Personne
Information form can be directed to staff at
Mission Personnel:
Phone: 1-800-334-7626 ext. 6124
Fax: 212-983-6377
E-Mail: mjobson@episcopalchurch.org


Narrative Section

Write your responses below. Try to find that fine line between writing too much (1/2 page per question) and too little (one or two sentences per question). The total of your responses should not be more than two or three typed pages.

  1. Tell us a little bit about yourself.
    Use these guidelines if you choose:
    - Qualities you have... Qualities you don't have
    - What are you good at? Not so good at?
    - Situations you are comfortable in... Situations you should stay away from
  2. Describe your Christian faith and how you see God is active in your life.
  3. What excites or intrigues you about global mission service?
    What do you anticipate to be most difficult or challenging for you?
  4. Describe any cross-cultural experiences you have had. What did you learn about your abi~ity
    to live and work in a cross-cultural context. (If you have had limited cross-cultural
    experience, describe how you see yourself living and working in a cross-cultural context).
  5. What other information or considerations to your candidacy do you wish to communicate?

Verify You Are Human