FORM NO. ACI/L/2022/………….

LICENSING/ORDINATION NOMINATION FORM

PASSPORT SIZE
PERSONAL PROFILE PICTURE

NAME OF CANDIDATE:

ACI BRANCH:

DATE OF BIRTH: AGE:

GENDER: PHONE NUMBER:

EMAIL ADDRESS:

ADDRESS:

RESIDENTIAL ADDRESS:

MARITAL STATUS: SPOUSE NAME *

CONTACT* EMAIL*

EDUCATION

INSTITUTION FROM TO AWARD GRADE

OTHER ACADEMIC/MINISTRY/LIFE ACHIEVEMENT:

EMPLOYMENT

EMPLOYER/ADDRESS:

DURATION OF EMPLOYMENT: POSITION:

NATURE/SCOPE OF WORK:

MINISTRY EXPERIENCE

NATURE/SCOPE OF MINISTRY:

NAME OF ORGANISATION: DURATION:

NAME OF SUPERVISOR/PASTOR:

PERSONAL VISION

VISION FOR SELF:

VISION FOR MINISTRY IN GENERAL:

VISION FOR ACI SPECIFICALLY:

HEALTH

HEALTH STATUS (Please state):

SPECIFIC HEALTH CHALLENGE:

HAVE YOU ANY KNOWN DISEASE? YES/NO:

ARE YOU ON ANY MEDICATION? YES/NO:

HAVE YOU BEEN INVOLVED IN ANY FORM OF ACCIDENT IN THE PAST FOUR YEARS?

YES/NO:

IF YES, EXPLAIN:

LEGAL RECORDS

HAVE YOU BEEN CHARGED WITH ANY CRIMINAL OFFENCE?

YES/NO:

IF YES, PLEASE INDICATE

STEALING ROBBERY RAPE QUARREL

FIGHTING DEFRAUDING OTHER

ANY OTHER CIVIL CASE? YES/NO:

IF YES, PLEASE INDICATE:

Please be informed that any false information given or any inconsistency detected will be considered as a serious matter according to
the provision of ACI Licensing/Ordination Policy, and that shall lead to your disqualification in the nomination to the election into
Licensing/Ordination Pastorate of Action Chapel International.

I........................................................................................................., AGREE THAT I SHALL BE DISQUALIFIED IF

ANY FALSEHOOD OR INCONSISTENCY IN ANY INFORMATION GIVEN

BY MY HAND REGARDING MY NOMINATION ACCORDING TO THE PROVISION OF THE

ACI LICENSING/ORDINATION POLICY TO ELECTION INTO THE PASTORATE OF

ACTION CHAPEL INTERNATIONAL

DATE:

SIGNATURE:

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CHAD USE ONLY

REVIEW (CHAD): ……………………………………………………………………………………………

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COMMENTS (COB): …………………………………………………………………………………………

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APPROVED/NOT APPROVED: ………………………………………………………………………….

SIGNATURE:

NAME:
DATE:
 APPENDIX 1
REFERENCE FORM

NAME (RESIDENT PASTOR)

REASON FOR NOMINATION

HOW LONG HAVE YOU KNOWN THE CANDIDATE?

WHAT DO YOU KNOW ABOUT THE CANDIDATE’S:
CHRISTIAN LIFE
EDUCATIONAL LIFE
SECULAR LIFE

FILL THIS TABLE WHERE APPLICABLE

EXCELLENT VERY GOOD GOOD NO
KNOWLEDGE
Communication Skills
Leadership Skills
Reliability
Work without Supervision
Team player
Intelligence
Exposure
Ministry Experience
Loyalty
Stability
Relationship with opposite sex
Health condition
Marital Life
General Assessment about the Candidate

HOW LONG HAS HE/SHE SERVED IN THE CHURCH AND IN WHAT CAPACITIES?

IS THE CANDIDATE INVOLVED IN THE HOME CELL SYSTEM?

YES NO

HOW MANY HOME CELLS HAS HE RAISED AND WITH HOW MANY MEMBERS?

HAS HE/SHE BEEN DISMISSED FROM ANY CHURCH? YES NO

IF YES, GIVE REASON

STATE HIS/HER REQUIRED ASSIGNMENT JUSTIFYING HIS/HER LICENSING

POSITION
BRANCH THUMBPRINT
OR STAMP
SIGNATURE
DATE

NAME OF REGIONAL BISHOP

COMMENTS ON REFERENCE

SIGNATURE
DATE