CONFIDENTIAL
APPLICATION FORM
Application for the office of
SECTION 1
Surname
Christian names
Address
Home telephone number
Mobile number
E-mail
Ordained deacon in the
In (year)
Diocese of
Ordained priest in the Diocese
In (year)
of
Lay ministers
First licensed/commissioned in
In (year)
the Diocese of
SECTION 2 – PRESENT APPOINTMENT
What is the title of your present office? Please give the date you started and a brief
outline of the work.
SECTION 3 – FURTHER EDUCATION AND PROFESSIONAL
QUALIFICATIONS
Please give details, with dates, most recent first.
a) Further education (including theological college or course). Please give
qualification obtained with class of degree.
From To Qualification/experience
b) Other professional/practical qualifications obtained (e.g. teaching, social work,
further study).
SECTION 4 – CAREER AND MINISTRY Please give details, with dates, with earliest
first. Please explain any gaps and give a relevant address for each appointment
a) Career before ordination – please give a brief indication, with dates, of the nature
of the work and responsibilities
From To Description (nature of work and responsibilities)
b) Offices held since ordination and any other work done (full and part-time not
including present appointment) with details of the nature of the work and responsibilities.
Please provide in date order, with earliest first, and explain any gaps.
Please list these, with separate entries for offices held concurrently (e.g. rural dean,
chaplaincies etc.). Please indicate major parish features (e.g. type of area, team ministry,
ecumenical). Please provide a contact address where the post is not parochial or
diocesan.
Contact address
Office and description (nature of work
From To if not a parochial
and responsibilities)
or diocesan post
c) Responsibilities in the wider Church
Please indicate tasks undertaken for the wider Church, e.g. synodical responsibilities at
any level, diocesan committees and working parties served on, ecumenical involvement,
or work for a Church voluntary organisation, and how you contributed to progressing
their agendas.
From To Description
d) Continuing ministerial education and development
Please list training courses attended and development activities undertaken e.g. mentoring
(other than IME 1-7) in the last 5 years. Include courses and activities both inside and
outside the Church.
e) Any publications
f) Theological and ecclesiological
What theological traditions have shaped your ministry and with which do you feel most at
ease today?
SECTION 5 – COMMUNITY AND OTHER INTERESTS
a) Responsibilities in the community
Please indicate your responsibilities in the community, e.g. school governor, political or
community service. What did you accomplish?
b) Other areas of interest
Please indicate your involvement in special areas of concern, e.g. particular issues in
contemporary life, international matters, academic or artistic interests. How have these
contributed to your ministry?
c) Other interests
Please indicate other recreational interests.
SECTION 6 – PERSONAL STATEMENT
Please state your reasons for applying for this office. What you write and how you write
it will help those making the appointment build up a picture of you. You will want to
outline how you meet each of the elements of the person specification, drawing on gifts,
skills, knowledge and experience from your previous career, both before and after
ordination, responsibilities held and relevant interests. You will also want to set out your
thoughts about how you will take forward some of the challenges and issues set out in the
role specification. If the office applied for is in a different church tradition from the one
you have come from give examples of how you have worked across traditions.
SECTION 7 – CONFIDENTIAL
This section will be removed by the person administering the application
process and will only be made available to the chair of the interview panel and
the bishop.
If you are appointed to the office you will be invited to provide information about you and
your family so you can receive appropriate pastoral care.
References:
Please give names, occupations and addresses (including e-mail if possible) of three
persons to whom reference can be made and the capacity in which they have known you.
At least one should be clerical (not the bishop as his reference is sought as a matter of
course) and one from a senior lay person – for example a current churchwarden or head
teacher of the local school. Referees should have a detailed up-to-date knowledge of your
work. Please obtain their permission. If you are a team vicar, priest-in-charge of a
daughter church or assistant curate, you should give your team rector’s or incumbent’s
name as a reference.
We expect to take up references before the interview unless you have indicated
otherwise. An Episcopal reference will always be taken up prior to interview.
Are your papers available from the Clergy Appointments Adviser? Yes/No
Health:
Please specify any special access requirements you may have in order to attend interview
e.g. deaf loop system
Do you have any health related condition that would affect your ability to carry out
functions that are intrinsic to the office? (See person specification for details.)
Marital status:
Please describe your marital status. You should specify whether you are single, married,
or in a civil partnership, separated, divorced, widowed, or formerly in a civil partnership
now dissolved. You should also specify whether you are divorced and remarried with a
previous spouse who was still living at the time of your marriage, and/or whether you are
married to a person who has been previously married whose former spouse was still
living at the time of your marriage.
Ecclesiastical Offices (Age Limits) Measure 1975
With very limited exceptions, appointment to an ecclesiastical office
can only be offered to priests over the age of 70 on a fixed or limited Yes/No
term licence. Are you under the age of 70?
UK Border Agency requirements
Are you free to remain and work in the UK with no current
Yes/No
immigration restrictions?
Please note that you will be required to produce documentary
evidence of your right to remain and work in the UK if you are
invited to interview.
Protecting children and vulnerable adults – the Confidential Declaration Form
The Confidential Declaration Form should be completed by all those wishing to work
with children and/or adults who are vulnerable. It applies to all roles, including clergy,
employees, ordinands and volunteers who are to be in substantial contact with children
and/or adults who are vulnerable. This form is strictly confidential and, except under
compulsion of law, will be seen only by those involved in the recruitment/appointment
process and, when appropriate, the Diocesan Safeguarding Adviser or someone acting in a
similar role/position. All forms will be kept securely in compliance with the Data
Protection Act 1998.
A Confidential Declaration can be found with this application form.
Promoting racial equality
Are you a member or an active supporter of any political party or other
organisation whose constitution, policies, objectives, activities, or public
statements are incompatible with the Church of England’s commitment to
Yes/No
promoting racial equality? The House of Bishops has made declarations of
incompatibility in respect of two organisations, namely the British National Party
and the National Front.
Where did you hear of this office?
If appointed when would you be available to
start?
I certify the information given in this application is correct
Signature Date
It is important that this application form is completed by applicants. A Curriculum Vitae is
not an acceptable substitute. If it is completed and submitted electronically a signed copy
should also be sent by post. Please use black ink on hard copies of the form.
A confidential reference will also be requested from your diocesan bishop or area bishop
in addition to other references. The Data Protection Act of 1998 applies to all references
and commendations.
The successful candidate will be required to receive an enhanced disclosure (which will
include a check of the barred lists) from the Disclosure and Barring Service.
Travelling expenses and subsistence allowance (in accordance with General Synod
regulations) will be allowed to candidates selected for interview.
Closing date for applications
Please
return to:
Interviews will be held on
NOTES FOR APPLICANTS
Increasingly role descriptions and person specifications are being used in appointments.
These help all parties to be clear about what qualities and experience are being sought
and on what basis the decision to appoint will be made.
This form helps you to demonstrate your calling to the office, showing how your gifts,
skills, experience and qualities match the criteria. It allows those making appointments to
demonstrate their discernment of the successful candidate by assessing applicants against
selection criteria in a structured way, avoiding bias. In completing the form you should ask
yourself “What might I under God be able to bring to the needs of this office?”
You are encouraged to complete the form electronically. This eases administration and
allows interviewers to concentrate on the facts you are presenting rather than having first
to read your handwriting. Start with the most recent one first when listing dates.
Please complete each section fully. Saying ‘see CV attached’, for example, is not sufficient.
Once you have completed the form read it through and check you have shown how you
meet each of the criteria.
Section 6 – Personal Statement allows you to explain why you are applying for the post
and, using examples from your previous work and experience, why you are suited to it.
Pull together the relevant information from other parts of the form. Don’t forget to
include information about things you have done in your career before ministry or relevant
interests. Concentrate on facts, things your interests have caused you to do, rather than
mentioning a general interest in a particular subject. But don’t be too detailed, 2 pages of
personal statement is enough. The interview gives the opportunity to explore these areas
further.
If there is a particular requirement about a post holder e.g. a PCC has passed a Resolution
under the House of Bishops’ Declaration on the Ministry of Bishops and Priests, and a
woman is therefore not an acceptable appointee or someone remarried after divorce and
with a former partner still living is not acceptable, the person specification needs to make
this clear and if appropriate you need to address it in your personal statement.
Some requirements however are more general and will not be mentioned in the person
specification. For example, the Ecclesiastical Offices (Age Limit) Measure 1975 does not
allow the appointment of those over 70 unless in a fixed or limited term licensed
appointment under regulation 29(1) (b). If you are in any doubt about your eligibility, you
should ask those responsible for making the appointment before you complete your
application.
Personal information is confined to the confidential part of the form. This means only the
person administering the process, the bishop and those who need to see it will have
access to it. It means those interviewing you are not influenced by factors that are not
relevant in making the appointment.
The bishop may ask you questions about the confidential information at your private
interview because he or she has to assure himself or herself that your lifestyle is
commensurate with a) priestly ministry and b) the person specification for the post.
If you are appointed, you will be invited to provide information about you and your family
so the bishop has the information he or she needs to provide you with pastoral care.
SAMPLE CLERGY RECRUITMENT MONITORING FORM
Please complete this monitoring form and send it direct to the monitoring
officer of the diocese in which you are applying to work. The information will
not be used as part of the selection process and will enable the diocese to
monitor the diversity of clergy applying for its offices. You may tick the ‘prefer
not to say’ box for any questions that you do not wish to answer.
Application for the office of:
1 What is your ethnic group?
A White
British Irish
Other
B Mixed
White/ Black Caribbean White/Asian
White/Black African Other
C Asian or Asian British
Asian British Pakistani
Bangladeshi Indian
Other
D Black or African or Caribbean or
Black British
African Caribbean African
Black British Other
E Other group
Chinese Other
F Prefer not to say
2 Gender
Prefer not to
Male Female
say
3 Age Group
16 – 25 26 – 35
36 – 45 46 – 55
56 – 65 66 – 70
Prefer not to
Over 70
say
4 Disability
Do you consider yourself to have a disability or a long term health condition?
Prefer not to
Yes No
say
5 Marital Status
Single Separated
Married Divorced
In a civil partnership Civil partnership dissolved
Married to a person who has
been previously married whose
Widowed
former spouse was still living at
the time of the marriage
Divorced and remarried with
a previous spouse still living at Prefer not to say
the time of the marriage
Form dated March 2015
Church Of England Confidential Declaration Form
The Confidential Declaration Form must be completed by all those wishing to work with
children and/or adults who may be vulnerable. It applies to all roles, including clergy,
employees, ordinands and volunteers who are to be in substantial contact with children
and/or adults who are vulnerable. This form is strictly confidential and, except under
compulsion of law, will be seen only by those involved in the recruitment/appointment
process and, when appropriate, the Diocesan Safeguarding Adviser or someone acting in a
similar role/position. All forms will be kept securely in compliance with the Data Protection
Act 1998.
If you answer yes to any question, please give details, on a separate sheet if necessary, giving
the number of the question which you are answering.
Please note that the Disclosure and Barring Service (DBS) is an independent body, which
came into existence on 1st December 2012. It combines the functions of the Criminal Records
Bureau (CRB) and the Independent Safeguarding Authority (ISA).
1. Have you ever been convicted of or charged with a criminal offence or been bound over
to keep the peace that has not been filtered in accordance with the DBS filtering rules1?
(Include both ‘spent2’ and ‘unspent’ convictions)
1 You do not have to declare any adult conviction where: (a) 11 years (or 5.5 years if under 18 at the
time of the conviction) have passed since the date of the conviction; (b) it is your only offence; (c) it
did not result in a prison sentence or suspended prison sentence (or detention order) and (d) it does
not appear on the DBS’s list of specified offences relevant to safeguarding (broadly violent, drug
related and/or sexual in nature). Please note that a conviction must comply with (a), (b), (c) and
(d) in order to be filtered. Further guidance is provided by the DBS and can be found at
www.gov.uk/government/publications/filtering-rules-for-criminal-record-check-certificates and
www.gov.uk/government/publications/dbs-filtering-guidance
2Please note that the ‘rehabilitation periods’ (i.e. the amount of time which has to pass before a
conviction etc. can become ‘spent’) have recently been amended by the Legal Aid, Sentencing and
Punishment of Offenders Act 2012. Since 10 March 2014, custodial sentences greater than 4 years
are never ‘spent’. For further guidance in relation to the ‘rehabilitation periods’, please see
http://hub.unlock.org.uk/knowledgebase/spent-now-brief-guide-changes-roa/
2. Have you ever received a caution, reprimand or warning from the police that has not been
filtered in accordance with the DBS filtering rules3?
Notes applicable to questions 1 and 2: Declare all convictions, cautions, warnings,
reprimands etc. that are not subject to the DBS filtering rules (see footnotes 4 and 6).
Broadly, where your position/role involves substantial contact with children and/or adults
who may be vulnerable you will be expected to declare all convictions and/or cautions etc.,
even if they are ‘spent’ provided they have not been filtered by the DBS filtering rules.
If your position/role does not involve substantial contact with children and/or adults who
may be vulnerable you should only declare ‘unspent’ and ‘unfiltered’ convictions/cautions
etc.
Convictions, cautions etc. and the equivalent obtained abroad must be declared as well as
those received in the UK.
If you are unsure of how to respond to any of the above please seek advice from an
appropriate independent representative (e.g. your solicitor) because any failure to disclose
relevant convictions, cautions etc. could result in the withdrawal of approval to work with
children and/or adults who may be vulnerable.
3. Are you at present (or have you ever been) under investigation by the police or an
employer or other organisation for which you worked for any offence/misconduct?
4. Have you ever been prohibited and/or barred from work with children and/or vulnerable
adults?
3 You do not have to declare any adult caution where: (a) 6 years (or 2 years if under 18 at the time of
the caution, reprimand or warning) have passed since the date of the caution etc. and (b) it does not
appear on the DBS’s list of specified offences referred to in footnote 1 above. Please note that a
caution etc. must comply with (a) and (b) in order to be filtered
5. Has a family court ever made a finding of fact in relation to you, that you have caused
significant harm to a child and/or vulnerable adult, or has any such court made an order
against you on the basis of any finding or allegation that any child and/or vulnerable adult
was at risk of significant harm from you4?
6. Has your conduct ever caused or been likely to cause significant harm to a child and/or
vulnerable adult, and/or put a child or vulnerable adult at risk of significant harm?
Note: Make any statement you wish regarding any incident you wish to declare
7. To your knowledge, has it ever been alleged that your conduct has resulted in any of
those things?
If yes, please give details, including the date(s) and nature of the conduct, or alleged
conduct, and whether you were dismissed, disciplined, moved to other work or resigned
from any paid or voluntary work as a result.
Note: Declare any complaints or allegations made against you, however long ago, that you
have significantly harmed a child, young person or adult who is vulnerable. Any allegation
or complaint investigated by the police, Children’s Services, an employer, voluntary body or
other body for which you worked must be declared. Checks will be made with the relevant
authorities.
4 ‘Significant harm’ involves serious ill-treatment of any kind including neglect, physical, emotional or
sexual abuse, or impairment of physical or mental health development. It will also include matters
such as a sexual relationship with a young person or adult for whom an individual had pastoral
responsibility or was in a position of respect, responsibility or authority, where he/she was trusted by
others.
8. Has a child in your care or for whom you have or had parental responsibility ever been
removed from your care, been placed on the Child Protection Register or been the subject
of child protection planning, a care order, a supervision order, a child assessment order or
an emergency protection order under the Children Act 1989, or a similar order under any
other legislation?
Note: All these matters shall be checked with the relevant authorities
Declaration
I declare the above information (and that on any attached sheets) is true, accurate and
complete to the best of my knowledge
Signed…………………………………….
Full Name………………………………..Date of Birth………………………………..
Address…………………………………………………………………………………………
…………………………………………………………………………………………………
…..
Date………………………………………..
Please return the completed form to
……………………………………………………………………………….
Before an appointment can be made applicants who will have substantial contact with
children and/or adults who may be vulnerable in their roles will be required to obtain an
enhanced criminal record check (with or without a barred list check (as appropriate)) from
the Disclosure and Barring Service.
All information declared on this form will be carefully assessed to decide whether it is
relevant to the post applied for and will only be used for the purpose of safeguarding
children, young people and/or adults who are vulnerable.
Please note that the existence of a criminal record will not necessarily prevent a person from
being appointed, it is only if the nature of any matters revealed may be considered to place a
child and/or an adult who may be vulnerable or at risk.
