DPD Chaplain Application

Detroit Police Chaplain Corps

http://www.dpdcc.org | E-mail: info@dpdcc.org
Membership Application

Submit the completed form and include all required references and supporting documentation. The information on this form and any attachments is secure and considered confidential. Contact email above for any questions.
I. Applicant Information

Many fields are required and must be completed
Full Name*

First NameMiddle NameLast NameSuffix
Enter Your Full Name*
Date of Birth

MonthDayYear
Attributes
Marital Status
Enter Spouse's Name
Your Contact Information
Home Address

Street Address

Street Address 2

CityState

Zip Code
Do you own a car?

YESNO
Phone Number
Please enter a valid phone number.
Email
example@example.com
Driver’s License / Personal ID Number
Issuing State

Street Address

Street Address Line 2

CityState

Zip Code

IV. Religious Intuitional Body Information
Name of Local Religious Institution Currently Serving
Religious Institution Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number of Religious Institution
Please enter a valid phone number.
Religious Institution Leader Name
Religious Denomination
Your Position / Title
Years of Ministerial Experience
Date Licensed

MonthDayYear
Date
Date Ordained

MonthDayYear
Date
Religious Ministerial Experience: List Institution Names, Full Addresses, Titles Held, Years Served at Each Institution, etc.

V. Academic Background Information
Seminaries & Religious Study Colleges: List Institution Name, Address and Details
Highschool Name, Address & Year Graduated
Colleges & Universities Attended: List Institution Names, Addresses, Majors, Years Attended and Degrees Obtained
Other Pertinent Experience

VI. Background History and Training Information
Briefly indicate your reasons for seeking membership with the Detroit Police Chaplain Corps
Do you carry a firearm or have a CPL / CCW permit?

YESNO
Have you ever been convicted of a felony?

YESNO
If yes, what agency and what for?
Will being a Detroit Police Chaplain present a problem with your employment?

YESNO
Please explain the employment conflict

VII. File Documents Upload

If your documents are available and ready, you can upload and submit them now with this application.
Important, the following documents are required with this application:

A. Your personal resume.

B. A letter of recommendation and endorsement from the religious leader or body to which you are accountable.

C. Two (2) letters of recommendation from recognized community leaders, e.g., Police Chaplain. Police Officer, Public Official.

D. A copy of your minister license and/or your ordination license.

E. A copy of your driver’s license.

F. Any other supporting documents you wish to submit
Check the box for the documents that you are submitting with this application

Your personal resumeYour driver’s licenseYour minister licenseYour ordination licenseRecommendation/endorsement letter from religious leader or body1st letter of recommendation from recognized community leader2nd letter of recommendation from recognized community leaderOther documents
File Upload

Cancelof
Use Your Device Camera

You may use the camera on your device to take a picture of your driver license.
Take Photo

VIII. Agreement and Certification

I hereby agree & certify that all information submitted is true & accurate to the best of my knowledge
Signature*

Powered by Jotform SignClear
Should be Empty:

Detroit Police Chaplain Corps