App 18 Application: Request Retirement (¶357) Name: Address:
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Best Contact # (______)________-__________ Birthdate: _________ _________ __________ [__] Cell [__] Home [__] Work Month Day Year Email: ______________________________________________________________________ Status: [__] Full Elder [__] Full Deacon [__] Associate Member [__] Local Pastor District: [__] AP [__] CM [__] HI [__] MV [__] NR [__] SS [__] SM [__] TV [__] TR Charge: ______________________________________________________________________ Having prayerfully considered my ministry and other factors in my life, I respectfully request that I be retired under the following provisions of ¶357: [__] Ad Interim (¶357.2.d) - Between sessions of the annual conference [__] Mandatory (¶357.1) - I will reach age 72 on or before July 1st prior to the date of requested retirement and / or next scheduled annual conference. [__] Voluntary with 20 Years of service (¶357.2a) – by the date of requested retirement and / or next scheduled annual conference. [__] Voluntary with 30 Years of service OR having reached age 62 (¶357.2b) – by the date of requested retirement and / or next scheduled annual conference. [__] Voluntary with 40 Years of service OR having reached age 65 (¶357.2c) – by the date of requested retirement and / or next scheduled annual conference. In addition to completing this Application, I also submit the attached letter stating my desire to retire. Effective date requested: ___________ ___________ __________ Month Day Year Submission deadlines: • To retire at the annual conference session, your application and letter should be received no later than 120 days prior to the annual conference session. February 1st is an appropriate date to meet this deadline requirement. • In the situation of Ad-Interim Retirement, enough time must be allowed between the date of the Application and the Effective date of requested retirement as to allow the Benefits office to get necessary items in place for healthcare and pensions. Please allow a minimum of 30 days between the date you submit the Application and the Effective date requested. During that time, action will need to be taken by the Bishop / Cabinet and then the Board of Ordained Ministry Executive Committee (BOMEC) and then the Benefits Office. __________________________ _________________________ ___________________ Signature Printed Name Date _____________________________________________________________________________________ Please submit copies of this application to: [__] Chair, Board of Ordained Ministry [__] The Office of the Bishop [__] The Director of Clergy Concerns via ConferenceSecretary@holston.org [__] The Appointment Cabinet via current District Superintendent Office Use: For Ad-Interim Retirements: Receipt of Request: Bishop / Cabinet [__] did / [__] did not approved this request: BOMEC [__] did / [__] did not approved this request: Office of Clergy Services submit results to Benefits Office:
Month _________ _________ _________ _________
Day _________ _________ _________ _________
Year __________ __________ __________ __________
Updated: 2020-11