Leadership Interest Registration – Northern California Nevada Conference

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Email Address*

Home Phone

Leave BLANK if none

Mobile Phone

Leave BLANK if none

Local Church of Membership*

Racial Identity*

Check any/all that apply

African American/Black
Asian
Latinx
Native American/Indigenous
Pacific Islander
White
Decline to Disclose

Gender Identity*

Age Range*

Are you a(n):*

Layperson
Authorized Ordained Minister (with Standing in NCNC)
Ordained minister without standing

Leadership Capacities & Skills

In this section, you are invited to share details of past leadership experience, skill sets, passion, or any other attribute you wish to share with the Committee as it evaluates individuals to consider for nomination.

If you have previously held leadership positions in any congregation, please describe. Include role, responsibilities, and dates. You may also include highlights or particular points of pride from your term of service.

If you have previously held leadership positions in any wider church setting (Association, Conference, etc), please describe. Include role, responsibilities, and dates. You may also include highlights or particular points of pride from your term of service.

If you have previously held leadership positions in any other non-church organization, please describe. Include role, responsibilities, and dates. You may also include highlights or particular points of pride from your term of service.

What skills or passions would you bring with your leadership service?

Why are you interested in leadership service in NCNC-UCC?

How many hours of effort are you willing and able to devote to leadership each month?

Consent to Disclosure*

I agree to the Background Disclosure requirements

If I am invited to apply for nomination, I understand that I will need to complete the Background Disclosure process. This will include a review of my personal and professional background, including potential conflicts of interest and a review of my criminal history. In addition, depending on my disclosure, I may need to participate in an Active Review process and provide relevant details to the committee to more fully understand my qualification to serve. I understand that if I am nominated and elected, the criminal background check must be completed prior to my beginning service.

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Leadership Capacities & Skills