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					Form MEPS 424 EA (05) Page 1 of 2                                                                                                   March 2005

                                         THE UNITED CHURCH OF CANADA
                      Ministry and Employment Policies and Services (Pastoral Relations)

                              Record of Ministry Personnel Eligible for
                                  Availability List (MEPS 424 EA)
                      This form must be used to record and monitor availability of ministry personnel.

Routing:
•    Ministry personnel completes this form and forwards to the Conference office.
•    Every person who signs this form must keep a copy for his/her own records.

Part A: Identification of Ministry Personnel
Full name:

Address:

                                                                                                      Postal code:

Telephone: Home                                                                Office

                Fax                                                            E-mail

Type of Ministry Preferred (solo, team, urban, rural, intentional interim, etc.)




Special Skills, Needs, Interests, Limitations




Conferences in Which Person Is Willing to Serve




    Please include my name on the Availability List.                              Please send me the Vacancy List.

Signature:                                                                                Date:



The use, retention and disclosure of personal information collected from this form is done in compliance with privacy legislation including, but
not limited to, the Personal Information Protection and Electronic Documents Act (2000, c.5). ** THIS FORM IS NOT VALID IF ALTERED **
Form MEPS 424 EA (05) Page 2 of 2                                                                                                   March 2005


Part B: Category of Ministry
   Ordained Minister                     Ordained Supply (non-United)                        Lay Pastoral Minister*
   Diaconal Minister                     Diaconal Supply (non-United)                        Lay Pastoral Minister-in-Training*
* Conference only.

Current/most recent presbytery/district:
                                                                               Name of presbytery/district

Attached documents:                        MEPS 401 IS                 MEPS 402 IS              and/or        résumé

Part C: Authorization of Release of Information
I authorize the Conference office to release any or all of the information summarized above and attached, to Joint
Search Committees or other potential employers, subject to the following limitations:

         None

         Limitations on release:



   Please include my name and information on the Conference/National Availability Listing.

   Please send me the Conference/National Vacancy Listing.


Month/Day/Year                   Signature: Ministry personnel                            Printed name: Ministry personnel


Part D: Record of Conference Office Receipt
I have reviewed the information summarized above, and attached documents:


Month/Day/Year                   Signature: Appropriate Conference staff                  Printed name: Appropriate Conference staff




The use, retention and disclosure of personal information collected from this form is done in compliance with privacy legislation including, but
not limited to, the Personal Information Protection and Electronic Documents Act (2000, c.5). ** THIS FORM IS NOT VALID IF ALTERED **

				
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