Name: | ||||||
Date of birth: | Phone number: | Email: | ||||
Church body to which you are incardinated: | ||||||
Name of Church authority: | ||||||
Address of Church authority: | ||||||
Appointment last held: | Commencement date on which you are seeking to minister in another Church body: |
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Has your request to minister in another Church body been approved by your Church authority? Yes No | ||||||
Current appointment: | Date from: | Date to: | ||||
Address 1: | ||||||
Previous appointment: | Date from: | Date to: | ||||
Address 2: | ||||||
Previous appointment: | Date from: | Date to: | ||||
Address 3: | ||||||
Previous appointment: | Date from: | Date to: | ||||
Address 4: | ||||||
Previous appointment: | ||||||
Address 5: | ||||||
Additional appointments should be detailed on a separate sheet and attached to this form. | ||||||
I hereby declare as follows:
1. The applicant has never been suspended or otherwise canonically disciplined.
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Yes
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No
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Comment
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I authorise the verification of the information provided on this form as to my previous ministries and personal information.
Signature __________________________________________ Date _______________________________ |