Chaplain s Endorsement Application

Transcription

1 Chaplain s Endorsement Application Check for which you are applying: 1910 E 4 th Ave, PMB #250 Olympia, WA Full-time Part-time Volunteer Campus Civil Air Patrol Correctional Institution Counseling Fire Department Healthcare Hospice Hospital Nursing Industrial/Workplace Law Enforcement Other INSTRUCTIONS: Thoroughly complete all responses. A signature is required. Please enclose a current photograph. ``````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````` For Office Use Only: Date Received College Transcripts Seminary Transcripts Life Sketch Understanding of Ministry Photograph CPE Evaluation Spousal Form & Photo References Pastor Ministry Peer

2 Current Supervisor or Co-worker Friend CPE Supervisor (if applicable) A. PERSONAL DATA 1. Full Name : a. First Middle b. Last Maiden 2. Date of Birth Place of Birth 3. Social Security No. 4. Home Address: Street/Apt/Box 5. City State County Zip code 6. Office Address: Street/Apt/Box 7. City State County Zip code 8. Phones: Home Office Cell 9. E- mails: Home Office 10. Fax 11. Are you in good health? Yes No 12. Physical challenges that might affect your ministry Please describe: 13. Have you ever been arrested and/or convicted? Yes No 14. If yes, please give the nature of the offense and the outcome:

3 15. Have you ever filed bankruptcy or had any serious financial difficulties? Yes No 16. If yes, give dates and please explain: 17. List hobbies, sports, and recreational interests: 18. List educational achievements, honors, awards, publications, etc.: 19. List your involvement in civic and community organizations: 20. Emergency contact: Name Relationship Phone Permanent address B. FAMILY AND MARITAL DATA 1. Marital status: Single Married Divorced Separated Widowed Remarried 2. Date of current marriage 3. Spouse full and maiden name

4 4. Spouse date of birth 5. Please explain your marital history if divorced, separated, or remarried: 6. To what extent does your spouse share/support your interest in pastoral ministry: 7. If you have children, list name(s) and birth date(s): Child s Name Birth Date Male/Female C. MINISTERIAL AND DENOMINATIONAL DATA: 1. District Membership: 2. Local Church Membership: 3. Local licensed minister: Yes No District When 4. District licensed minister: Yes No District When Deacon or Elder track? Yes No 5. Ordained minister? Yes No District When 6. Have you previously applied for endorsement? Yes No District With whom? 7. What disposition was made of this previous application?

5 8. Ministerial experience, beginning with the present: Church or Employer Address Position Dates served: From To D. EDUCATIONAL DATA 1. College and Seminary training (do not use initials for school names) 2. Please submit a copy of college transcripts. Name of College/Seminary Address Year(s) Attended From To Major Degree Conferred 3. Have you had any Clinical Pastoral Education (CPE)? Yes No Number of units: When Where Please submit a copy of all documentation associated with CPE evaluations. 4. Other specialized chaplaincy training you have received, certifications and/or membership: E. NON- MINISTRY EMPLOYMENT DATA: Please include a copy of your current resume.

6 F. REFERENCES Requested references are meaningful information from those who know you well enough to evaluate your ministry talents. A reference cannot be an immediate family member or relative. Full name Complete mailing address Telephone Fax 1. Pastor 2. Ministry Peer 3. Current Supervisor or Co- worker 4. Friend G. DISCUSSION: Write a minimum of three (3) paragraphs each. 1. Why do you desire to serve as a chaplain? 2. How have you prepared yourself for chaplaincy ministry? 3. List, explain and discuss some major functions of a chaplain.

7 4. Discuss challenging areas confronting chaplaincy ministry. 5. List your ministry strengths in regard to chaplaincy ministry. 6. What would be at least two areas of your personal character growth in regard to chaplaincy ministry? 7. What is your concept of financial stewardship?

8 8. Discuss your understanding of pastoral care in a pluralistic setting. H. LIFE SKETCH Prepare a testimony of yourself (at least 200 words attach a separate page if necessary)

9 STATEMENT OF UNDERSTANDING AND COMMITMENT (Please be sure you read this carefully before signing. If you have any questions, please call.) We MUST have a hand- signed signature below, so this page only needs to be either: o 1) signed and faxed OR o 2) signed, scanned, and ed as an attachment OR o 3) signed and mailed 1. I understand the granting of the endorsement as a chaplain while representing the Church of the Nazarene is a privilege. 2. I understand that if registered, endorsed, commissioned or appointed as a chaplain, I will be working with chaplains of other denominations and faith groups, sometimes differing widely with my own views and beliefs. While I will not be asked to compromise my own conscience and beliefs, it is essential, by the very nature of chaplaincy that I will be sensitive to the pluralistic nature of my ministry. I have read and I agree to abide by the beliefs and practices of the most recent edition of the Manual of the Church of the Nazarene. 3. I am responsible to keep my district informed in a timely fashion of contact information changes. 4. As with all ministers, submission of the Annual Chaplain Report is mandatory. 5. Applicants for Bureau of Prisons only: I agree to waive my Second Amendment Rights (Bearing of Arms) while in the conduct of my official duties as a chaplain. Print or type full name clearly: Signature: Date: Permanent Address and Phone Number if different than in Personal Data: Street/Apt./Box City State Zip code Phone Cell Phone Mail to: to (scanned signed copy): Fax to: Washington Pacific District Office WaPac Chaplaincy Ministries (360) E 4 th Ave, PMB #250 info@wapacnaz.org Olympia, WA Office Phone (360)