Chaplaincy Questionnaire CHAPLAINCY COMPLETE THE FORM CHC42315 Certificate IV in Chaplaincy and Pastoral Care - Questionnaire If you are human, leave this field blank. Name of Student Applicant. Student Applicant's Email Student Applicants Phone Your Pastors - Email Address * Chaplaincy experience * I am currently not a chaplain, but seeking to become a chaplain (complete Parts A & B of this questionnaire) I am currently working as a chaplain and seeking further training (complete Part B of this questionnaire only – a letter verifying your employment hours, roles and responsibilities will be required once you have received your Letter of Acceptance into this course) PART A: ANSWER THE FOLLOWING QUESTIONS Why would you like to work as a Chaplain? * Have you had any previous experience or association with Chaplaincy? Give brief details. * What personal qualities would you consider to be important for a Chaplain to demonstrate? * Are you willing and available to work flexible hours in a chaplaincy role, being accountable to your local church and workplace?(give reasons) * Have you ever been charged or investigated for a criminal offence?* * No Yes, if yes write a brief explanation: * Disclosure of this information will not automatically disqualify you from entry into a course. Disclosure is necessary because this information may or may not have a direct bearing on your suitability for vocational placement as a trainee Chaplain. Hope College has a duty of care to disclose such information to potential vocational placement providers prior to accepting a applicant’s enrolment. Brief explanation: Are you willing to obtain a suitability card and/or police check if required by your vocational placement provider, at your own expense? * Yes No Positive criminal history screening card (check the requirements of the state/territory in which you are ministering for working with children, youth, aged and disability) * Yes No Have you obtained a Police Check. * Yes No Further explanation. PART B: READ THE CODE OF CONDUCT AND SIGN THE DECLARATION CHAPLAINS’ CODE OF PROFESSIONAL CONDUCT - Australian Christian Churches The Code of Professional Conduct requires Endorsed Chaplains/Team Chaplains to be personally responsible and accountable for their practice and conduct as provided by this Code. Members are required to: Be a committed Christian who holds to the Apostles Creed and the doctrines held by their relevant denomination. Maintain the highest ethical standards in their own personal life. Be personally accountable for their professional conduct to their employing authority and/or Church authority. Maintain the highest standards of professional competence and integrity in the pastoral, spiritual and religious care of recipients. Exercise the greatest sensitivity and discretion in matters of confidentiality, privacy and respect for others. Continue to undertake professional development, enhancing their chaplaincy skills; including attendance at Chaplaincy Australia Conferences and regional meetings. Co-operate fully with industry professionals, Chaplaincy colleagues and representatives of the Church in providing holistic care to others. Respect at all times the religious faith, practice and belief systems of clients. Provide for the appropriate pastoral, spiritual and religious services required by recipients. Ensure that no personal action or omission, within their own area of responsibility, is contrary to the highest standards of care or to the welfare of recipients. Be an active member of a local Church fellowship. Meet with their Senior Minister (or their appointee) periodically to discuss their ministry and to ensure that accountability and encouragement is being received. Engage in regular mentoring/supervision that contributes to your own personal, spiritual and professional development. DECLARATION: I declare that the information I have written on this form is correct. I understand that depending on the requirements of my vocational placement, I may need to obtain a suitability card and/or a police check at my own expense. I understand that a vocational placement provider has the right to refuse or terminate my access to their workplace as a volunteer, should my behaviour at any time violate their code of conduct. I understand that the information on this document is private and confidential but may need to be disclosed to a vocational placement provider. I have read and will abide by the Chaplains’ Code of Professional Conduct written above. I declare that the information I have written on this form is correct. * Yes No Date Alternative Methods to submit this reference Person: Hope Building 4, 175 Varsity Parade, Varsity lakes, Qld 4227 Phone +61755510269 Fax: +61756417810 Print then Post to: Box 35 Varsity Lakes Qld 4227 Email: email@example.com Phone Privacy Privacy Notice. Under the Data Provision Requirements 2012, Hope College is required to collect personal information about you and to disclose that personal information to the National Centre for Vocational Education Research Ltd (NCVER). Your personal information (including the personal information contained on this enrolment form), may be used or disclosed by Hope College for statistical, administrative, regulatory and research purposes. Hope College may disclose your personal information for these purposes to: • Commonwealth and State or Territory government departments and authorised agencies; and • NCVER Personal information that has been disclosed to NCVER may be used or disclosed by NCVER for the following purposes: • populating authenticated VET transcripts; • facilitating statistics and research relating to education, including surveys and data linkage; • pre-populating RTO student enrolment forms; • understanding how the VET market operates, for policy, workforce planning and consumer information; and • administering VET, including program administration, regulation, monitoring and evaluation. You may receive a student survey which may be administered by a government department or NCVER employee, agent or third party contractor or other authorised agencies. Please note you may opt out of the survey at the time of being contacted. NCVER will collect, hold, use and disclose your personal information in accordance with the Privacy Act 1988 (Cth), the National VET Data Policy and all NCVER policies and protocols (including those published on NCVER’s website at www.ncver.edu.au).