App 12 Application: Request for Less Than Full Time Service Name: Address:
______________________________________________________________________ First Middle Last ______________________________________________________________________ Street City State Zip
Best Contact # (______)________‐__________ Birthdate: [__] Cell [__] Home [__] Work
_________ _________ __________ Month Day Year
Email:
______________________________________________________________________
Clergy Status: District:
[__] Full Elder [__] Full Deacon [__] Associate Member [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR
Charge:
______________________________________________________________________
I desire to serve:
[__] 1/4 time
[__] 1/2 time
[__] 3/4 time
Reason for requesting Less Than Full Time Service: [__] 1.) Limited Itinerancy — ¶338.2.a).(1) You must submit a written letter, along with this application, stating that itineracy is limited due to temporary constraints which you are facing. Those constraints should be spelled out in the letter. Present the letter to the following persons: [__] The Bishop [__] The Chair of the Board of Ordained Ministry [__]
2.)
Self‐Initiated — ¶338.2.a).(2) You must submit a written letter, along with this application, stating your request and the reasons for your desire to serve in a less than full time capacity. This request should be submitted at least 90 days prior to the annual conference session. The request should be submitted to: [__] The Bishop [__] The Chair of the Board of Ordained Ministry
[__]
3.)
Bishop‐Initiated — ¶338.2.a).(3) You will be notified via letter from the Bishop 90 days prior to the termination of your current appointment should the Bishop decide this is necessary for missional purposes.
Request for Continuation of Less Than Full Time Services: [__] 1.) After consultation with my District Superintendent and having been previously granted a less than full time appointment, I request that I continue in this status for the upcoming Annual Conference year.
Please submit to: [__] Chair, Board of Ordained Ministry [__] The Office of the Bishop [__] The Office of Clergy Services via ClergyServices@holston.org 1 of 2
Updated: 2022-11
App 12 Application: Request for Less Than Full Time Service Acknowledgements: Initial here
I acknowledge that I have contacted the conference health insurance administrator and discussed any ramifications my request might have upon my health insurance.
Initial here
I acknowledge that I have contacted the conference pensions administrator and/or Wespath and discussed any ramifications that my request might have upon my pensions.
Initial here
I understand that my request must receive the approval of both the cabinet and the Board of Ordained Ministry and that the full connection members of the clergy session must confirm my request by a 2/3 vote at its next scheduled session.
Initial here
I understand that if I continue to desire to serve in a less than full time capacity, that Holston Annual Conference requires me to request this on an annual basis with the request submitted by February 1st of each successive year.
Initial here
I understand that when I desire to come back into full time service that I must submit a written request to the Bishop and Cabinet at least six months prior to the annual conference session at which I desire to return to full time service. (December 1st will be an appropriate deadline.)
__________________________ Signature
_________________________ Printed Name
___________________ Date
_____________________________________________________________________________________ Office Use: Request [__] was / [__] was not granted. Request Granted: ______ _____ 20______ Becomes Effective: ______ _____ 20______ Month Day Year Month Day Year
Please submit to: [__] Chair, Board of Ordained Ministry [__] The Office of the Bishop [__] The Office of Clergy Services via ClergyServices@holston.org 2 of 2
Updated: 2022-11