SLEC Chaplain Application

SLEC Chaplain Application

Please list your current Pastor, someone unrelated to you, and a coworker (if unemployed or retired, use another person unrelated to you ) that can attest to your character, skills, and reliability.
Applicant Information
Applicant's Name

First NameLast Name
Submission Date

MonthDayYear
Date
Date of Birth

MonthDayYear
Date
CA DL
SSN
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email Address (Personal)
example@example.com
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Employment Information
Place of employment
Supervisor’s name
Supervisor’s Title
Supervisor Email Address
example@example.com
Supervisor Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Information
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Education Information
Languages spoken other than English and level of proficiency.
Highest level of education
Name(s) of institution(s)
Degree(s) or Certificate(s) earned (year)
Area(s) of study (All that apply)
Ministerial Information
Licensed/commissioned/ordained as a minister
Minister license/ordination date

MonthDayYear
Date
Church or Denomination
Church/Denomination Phone
Please enter a valid phone number.Format: (000) 000-0000.
Church/Denomination Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Pastor Name
Pastor Years Known
Pastor Church Name and Address
Pastor Email Address
example@example.com
Pastor Phone
Please enter a valid phone number.Format: (000) 000-0000.
References
Coworker Name
Coworker Years Known
Coworker Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Coworker Email Address
example@example.com
Coworker Phone
Please enter a valid phone number.Format: (000) 000-0000.
Additional Reference Name
Additional Reference Years Known
Additional Reference Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Additional Reference Email Address
example@example.com
Additional Reference Phone
Please enter a valid phone number.Format: (000) 000-0000.
Background and Motivation
Have you ever been arrested for a crime? If so, explain
Have you ever been discharged or forced to resign from any job for misconduct or unsatisfactory service? If so, explain
Have you ever been asked to step down from any ministry position? If so, explain
Why do you wish to become a volunteer Chaplain with the Sierra Chaplaincy and how long have you had this desire?
Special training or experiences applicable to Chaplain work
Consent and Signature
Permission to receive emails/newsletters/updates
Please read before signing:

I certify that all information is true and has been given voluntarily. I understand that this information may be disclosed to any party with legal and proper interest. I release the agency from any liability whatsoever for supplying such information.

Upon being offered a volunteer position, I understand that I may be required to provide additional information pertinent to the position for which I applied.

Thank you,

Sierra Chaplaincy
Use your mouse or trackpad to sign the document
Applicant Signature
Should be Empty:

SLEC Chaplain Application

Applicant Information

Employment Information

Emergency Contact Information

Education Information

Ministerial Information

References

Background and Motivation

Consent and Signature