Clergy Application Form Confidential

Application for the office of

Where did you hear about this

vacancy?

SECTION 1

Surname

First names

Address

Mobile number

Home phone number

E-mail

Ordained deacon in the Diocese of In (year)

Ordained priest in the Diocese of In (year)

Lay ministers

First licensed/ commissioned in

In (year)
the Diocese of
 Clergy Application Form Confidential

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.
 Clergy Application Form Confidential

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)
 Clergy Application Form Confidential

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, 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.

Office and description (nature of work and Contact address if not a

From To
responsibilities) parochial or diocesan post
 Clergy Application Form Confidential

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.
 Clergy Application Form Confidential

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?
 Clergy Application Form Confidential

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.
 Clergy Application Form Confidential

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.
 Clergy Application Form Confidential

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
 Clergy Application Form Confidential

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 term Yes/No
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 immigration
restrictions? Yes/No
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 experiencing, or at risk of abuse or neglect. 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 experiencing,
or at risk of abuse or neglect. 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 below.

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 Yes/No
 Clergy Application Form Confidential

incompatible with the Church of England’s commitment to 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 See specific

applications role details Please
[email protected]
See specific return to:
Interviews will be held on role details
 Clergy Application Form Confidential

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.
 Clergy Application Form Confidential

CLERGY RECRUITMENT MONITORING FORM

Please complete this monitoring form and return it with your application form. 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
 Clergy Application Form Confidential

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 former
Widowed
spouse was still living at the time of
the marriage
Divorced and remarried with
a previous spouse still living at the Prefer not to say
time of the marriage
 Clergy Application Form Confidential

Before an appointment can be made applicants who will have substantial contact with children and/or adults
experiencing , or at risk of abuse or neglect in their roles will be required to obtains 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 experiencing, or at
risk of abuse or neglect.
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 experiencing or at risk
of abuse or neglect at risk.
Privacy Notice

Your person data will be treated as strictly confidential and will only be shared with those involved in the
appointment process and where appropriate, the Diocesan Safeguarding Adviser.
The diocesan privacy notice for job applicants can be accessed using the following link
https://www.sheffield.anglican.org/privacy.
 Confidential Declaration Form for roles meeting the criteria for an
enhanced Disclosure & Barring Service check

Confidential Declaration Form and Privacy Notice Guidance

This form must be completed by all applicants for roles engaging in regulated activity i or roles working/having
substantial contact with children and/or vulnerable adults. This includes all Clergy ii, as well as all Church
Officersiii who are applying for a role that has been assessed as requiring an Enhanced Disclosure and Barring
Service (DBS) (with/without Barred List) check. The nature of these roles means they are exempt from the
provisions of Section 4(2) of the Rehabilitation of Offenders Act (1974 (ROA 1974) by virtue of the Rehabilitation
of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013 and 2020) (the ROA Order 1975 (as
amended)).
All individuals applying to work/volunteer in such roles will be subject to a satisfactory Enhanced DBS
(with/without Barred List) check before the appointment is confirmed as well as a satisfactory Enhanced DBS
(with/without Barred List) re-check every 3 years.
You are required to disclose all unspent convictions and conditional cautions and all spentiv convictions and adult
cautions that are not protectedv (i.e. that are not filtered out) as defined by the ROA Order 1975 (as amended)).
The ROA Order 1975 (as amended) provides that when applying for certain jobs and activities, certain convictions
and cautions are considered ‘protected’. This means that they do not need to be disclosed to employers/voluntary
organisations and, if they are disclosed, cannot be taken into account.
A criminal record will not necessarily exclude an individual from consideration for appointment. This will depend
on the nature of the role applied for and the circumstances and background of the offences. All information
declared on this form will be carefully assessed to decide whether it is relevant to the role applied for and will only
be used for the purpose of safeguarding children and/or vulnerable adults. If you answer yes to any question, please
provide details, on a separate sheet if necessary, giving the number of the question that you are answering.
If it is later discovered that any statement is false or misleading, then depending on the nature of your engagement,
it may lead to disciplinary procedures, where appropriate, and/or dismissal from your post/role. If you are unsure of
how to respond to any of the questions, please seek appropriate advice e.g. from the appointing
organisation/responsible person/recruiter, an organisation such as NACRO or Unlock vi, or a solicitor.
Registered Bodies and those in receipt of DBS Update Service information must fulfil the DBS Code of Practice
requirement to have a written policy on the recruitment of ex-offenders in place vii. Copies of these documents are
available on request and the DBS Code of Practice is available from the DBS via DBS code of practice - GOV.UK
(www.gov.uk)
The accompanying Privacy Notice explains how the information you supply on this form is used and your rights
with respect to that data as required by the UK General Data Protection Regulation, (the “UK GDPR”), and the
Data Protection Act 2018, (the “DPA 2018”). If applicable, please inform relevant members of your household
that you have included their details on this form and give them a copy of the Privacy Notice (it will only be
applicable if members of your household have been included in the response to a question on the form, e.g. Qs.6 &
7).
This Confidential Declaration Form and Privacy Notice must be used within the Diocese in Europe, the Channel
Islands and Sodor & Man, subject to relevant legislative variations/modifications and/or unless there is specific
local legislation in a jurisdiction that would prevent its use in its current format.
 Confidential Declaration Form for roles meeting the criteria for an
enhanced Disclosure & Barring Service check

Section A PERSONAL DETAILS

This section must be completed by all applicants.

Title (Mr/Mrs/Miss/Ms/Other): Click or tap here to enter text.

Surname: Click or tap here to enter text.

Forename(s): Click or tap here to enter text.

D.O.B.: Click or tap here to enter text.

Home Address: Click or tap here to enter text.

Click or tap here to enter text.

Click or tap here to enter text.

Telephone No.: Click or tap here to enter text.

Role Applied for: Click or tap here to enter text.

Role Location: Click or tap here to enter text.

 Confidential Declaration Form for roles meeting the criteria for an
enhanced Disclosure & Barring Service check

Section B

Please fully complete all relevant sections.

1. Do you have any unspent conditional cautions or convictions under Yes No

the Rehabilitation of Offenders Act 1974? If yes, please provide ☐ ☐
details:

Click or tap here to enter text.

2. Do you have any adult cautions (simple or conditional) or spent Yes No

convictions that are not protected as defined by the Rehabilitation of ☐ ☐
Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013
and 2020)?
If yes, please provide details:

Click or tap here to enter text.

3. Are you aware of any criminal/police enquiries/investigations Yes No

undertaken following allegations made against you which may have a ☐ ☐
bearing on your suitability for the post? If yes, please provide details:

Click or tap here to enter text.

4. Are you at present the subject of any criminal/police Yes No

enquiry/investigation/pending prosecution which may have a bearing ☐ ☐
on your suitability for the post? If yes, please provide details:

Click or tap here to enter text.

5. Is your role deemed “home based”, as per the DBS definitionviii?

Yes (proceed to Question 6.) No (proceed to Question 8.)

 Confidential Declaration Form for roles meeting the criteria for an
enhanced Disclosure & Barring Service check

6. If you are working from home with children, is there anyone who is Yes No
16 years of age or over living or employed in your household who has ☐ ☐
any unspent conditional cautions or convictions under the
Rehabilitation of Offenders Act 1974 and/or any adult cautions
(simple or conditional) or spent convictions that are not protected as
defined by the Rehabilitation of Offenders Act 1974 (Exceptions)
Order 1975 (as amended in 2013 and 2020)? If yes, please provide
detailsix:

Click or tap here to enter text.

Yes No
7. If you are working from home with children, is there anyone who is ☐ ☐
16 years of age or over living or employed in your household who is
at present the subject of a criminal/police enquiry
investigation/pending prosecution? If yes, please provide details:

Click or tap here to enter text.

8. Have you lived, worked or volunteered outside the United Kingdom Yes No
for a continuous period of six months or more at any point within the ☐ ☐
previous 10 years? If yes, please provide details, including the name
of the country/countries:

Click or tap here to enter text.

9. Does your role involve engaging in regulated activity with childrenx?

Yes (proceed to Question 10.) No (proceed to Question 11.)

10. Are you or have you ever been barred from work with children? Yes No
☐ ☐

11. Does your role involve regulated activity with vulnerable adultsxi?

Yes (proceed to Question 12.) No (proceed to Question 13.)

12. Are you or have you ever been barred from work with vulnerable Yes No
adults? ☐ ☐

13. Are you currently or have you ever been subject to any formal action Yes No
as a result of an allegation that your conduct has amounted to, resulted ☐ ☐
in or put a child and/or vulnerable adult at risk of harmxii? If yes,
please provide details:
 Confidential Declaration Form for roles meeting the criteria for an
enhanced Disclosure & Barring Service check
Click or tap here to enter text.

14. Are you currently or have you ever been subject to a court order either Yes No
made against you or in relation to you that you have caused harm to a ☐ ☐
child and/or vulnerable adult, or that a child and/or vulnerable adult
was at risk of harm from you? If yes, please provide details and a
copy of the court order:

Click or tap here to enter text.

15. This question must be answered in relation to circumstances that have arisen from a child/ren being in
your care. If you are an adoptive and/or foster parent and the circumstances either relate to the child/ren’s
previous situation, or to the removal/placement/child protection or child in need plan, which formed part
of the planned management or transition of the child/ren into your care, then you do not need to answer
yes to this question.

Has a child/ren in your care or for whom you have or had parental Yes No
responsibility ever been removed from your care, placed by you in ☐ ☐
care and/or been made subject to a child protection or child in need
plan as a result of a safeguarding concern that has arisen whilst the
child/ren has been in your care and/or in relation to your provision
of their care? If yes, please provide details:

Click or tap here to enter text.

16. Is there any other information that may be considered relevant to the Yes No
questions in this Confidential Declaration Form, and which may ☐ ☐
have a bearing on your suitability for the post you are applying for,
(i.e. working with children and/or vulnerable adults)? If yes, please
provide details:

Click or tap here to enter text.

Declaration

I declare the above information and that on any additional sheets (number attached: __) is true, accurate and
complete to the best of my knowledge. After I have been appointed and during my appointment, I agree to
inform the responsible person immediately if my answers to any of the above questions change and provide the
relevant details.

Signed: Date:
Click or tap here to enter text. Click or tap to enter a date.

Consent statement (this statement should only be signed if the answer to Question 8. is Yes)
I consent to my details being transferred outside the UK for the purposes of an overseas criminal records check.
 Confidential Declaration Form for roles meeting the criteria for an
enhanced Disclosure & Barring Service check
Signed: Date:
Click or tap here to enter text. Click or tap to enter a date.

Please return this completed form with the Application Form as a whole.
i
Eligibility guidance for enhanced DBS checks - GOV.UK (www.gov.uk)

ii
Applies to all Church of England ordained and licensed Clergy including Archbishops, Bishops, Archdeacons, Deans,
stipendiary parish Clergy, self-supporting Minister / non stipendiary Ministers, Chaplains, locally ordained Clergy,
Clergy with ‘permission to officiate’ (PTO), and those seeking ordination training or ordination.

iii
A Church Officer is anyone appointed/elected by or on behalf of the Church to a post or role, whether they are
ordained or lay, paid or voluntary.

iv
Please note that the ‘rehabilitation periods’ (i.e. the amount of time which has to pass before a conviction etc. can
become ‘spent’) have 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/

v
The Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013 and 2020) provides that
when applying for certain jobs and activities, certain convictions and cautions are considered ‘protected’. This means
that they do not need to be disclosed to employers, and if they are disclosed, employers cannot take them into account.
Convictions:- 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 did not result in a prison sentence or suspended
prison sentence (or detention order) and (c) 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) and (c) in order to be filtered.
Cautions:- You do not have to declare any adult caution where: (a) 6 years have passed since the date of the caution
etc. and (b) it does not appear on the DBS’s list of specified offences. As of 28 November 2020, reprimands, warnings
and youth cautions, are automatically filtered. Please note that a caution etc. must comply with (a) and (b) in order
to be filtered.
Further guidance is provided by the DBS and can be found at https://www.gov.uk/government/publications/dbs-
filtering-guidance/dbs-filtering-guide

vi
https://www.nacro.org.uk/ https://unlock.org.uk/

vii
DBS sample policy on the recruitment of ex-offenders - GOV.UK (www.gov.uk)

viii
Home-based position definition and guidance - GOV.UK (www.gov.uk)

ix
Please inform relevant members of your household that you have included their details on this form (if applicable) and
give them a copy of the Privacy Notice.

x
Keeping children safe in education - GOV.UK (www.gov.uk)

xi
New disclosure and barring services - GOV.UK (www.gov.uk)

xii
‘harm’ involves ill-treatment of any kind including neglect, physical, emotional, financial 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. It also includes domestic abuse.