Operating Committee Request Form

Please complete the form below in detail. Attach an additional sheet if necessary. All requests must be accompanied by comments from your Pastor (Associate Pastor if you are a member of the Jeffersonville church). After we have prayed over your requests, you will receive a letter from Reverend Hicks sharing with you the guidance we have received on your behalf. Comments from the Pastor and the Individual will be kept confidential.

1. Job Change / Employment

Last Name: First Name: Date: 09/21/2002

Address: Phone:

City: State: Zip: Age:

Are you consistent in paying your tithes? Yes No

Are you consistent in paying your First Fruits? Yes No

Will you appear for this session? Yes No Confirmed appointment date ____/____/____

Briefly, the details of my situation are:

Information

1. You are? Working Not Working

If you are not working, what is the date of your last employment?

2. Were you terminated? Yes No

If so, explain why:

3. Did you quit? Yes No

If so, explain why:

4. If you are presently working, explain why are you seeking a change?

5. Do you have a job offer now? Yes No

Describe

6. What are your job skills?

7. State your options in light of your present circumstances:

8. After prayer, what is your personal preference?

9. Who have you counseled with?

Please pray over my concerns listed above and share with me the insight you receive through the Witness of the Holy Spirit. I understand that you are not telling me what to do, but merely trying to help me grow closer to God throughout the circumstances of my life. I understand that as always I am fully responsible for any decisions I make in applying this insight to my life and in following the Light that God reveals personally to me.

Signature:

Revised 9 19 02