New Pastor Form

Please complete this form for the district office. Your information is kept secure and will be deleted off the server once it is downloaded.

Pastor Information
First Name*
Preferred Name/Nickname
Middle Initial*
Last Name*
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Do you have a different mailing address?*
- Yes
- No
Mailing Address
Street Address Address Line 2 City State ZIP Code

Mailing address, if different from Home Address
Primary Phone*
Email*

Please enter your preferred email for district communication
Date of Birth*
Month
Day
Year
Relationship Status*
- Married
- Engaged
- Single
Spouse's Name*
First Last
Spouse's Email
Spouse's Date of Birth*
Month
Day
Year
Wedding Anniversary
Month
Day
Year
Spouse's Employment

Spouse's place of employment other than church.
Other Work Place

Please enter your place of employment, if you are employed outside the church.
Children (living at home)
Child Name Date of Birth
Year of First Appointment

Please enter the year and District where you were first appointed by the District Conference as a licensed minister.
Ordination Date

Please enter the year of your ordination. Give the exact date if you know it.
Ordaining District

Please enter the name of the District which ordained you.
Retirement Year

If you are a retired ordained minister, please give the year you were designated by the District Conference as retired.
Appointment*
- I am a Pastor in a WNY District Church
- Other
Check which applies to your appointment with the Western New York District.
Background Check Consent
The District performs a background check on all appointed pastors. Please complete the fields below, which will constitute your consent for this background check.
Social Security Number*
Drivers License Number and State of Issuance
Previous Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Authorization*

I hereby authorize the Western New York District of the Wesleyan Church and/or its agents to make an independent investigation of my background, references, character, past employment, education, criminal, or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my resume’/job application and/or obtaining other information, which may be material to my qualifications for employment now, and if applicable, during the tenure of my employment with the Western New York District of the Wesleyan Church. I release the Western New York District of the Wesleyan Church and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims, or lawsuits in regards to the information obtained from any and all of the above referenced sources used. The following is my true and complete legal name, and all information is true and correct to the best of my knowledge.
Today's Date*
Month
Day
Year

Child Name	Date of Birth

New Pastor Form

Pastor Information

Background Check Consent

Pastors