NHS CHAPLAINCY

CHRISTIAN DENOMINATIONAL ASSESSMENT FORM

The NHS Trust or Primary Care Trust, a secular body, appoints to Christian chaplaincy posts candidates who are accredited to their respective denomination, e.g. s/he holds the Bishop’s Licence or is recognised as a qualified minister. This form provides a means for the Trust to discover the standing of applicants with their sponsoring denomination via the recognised authorities of the appropriate denomination.

Some of the questions may duplicate questions of the Trust’s Application Form. Nevertheless, please complete this form, which will be processed separately.

NAME & TITLE:

ADDRESS, PHONE NUMBER & E-mail:

For Anglicans & Roman Catholics:

                                                            Date                             Bishop

Ordination to Deacon’s Orders:

Ordination to Priest’s Orders:

For Free Church Ministers:

Date:                   Ordaining/Accrediting Denomination

Ordination/Accreditation:

Present Denomination:

Free Church applicants should be ministers of the member churches of the Free Churches Group, Churches Together in England. Other applicants, whose churches do not belong to this Group, should give full details on how to verify their Ordination/Accreditation.

DETAILS of posts, relevant to this application, held since full accreditation:

Dates               Position held

DETAILS of theological education and ministerial formation:

Dates               Qualification

DETAILS of health care chaplaincy training courses undertaken:

Dates               Course & content                                             Organised by

I understand the purpose of this form and agree that the information provided may be used for the purpose of confidential ecclesiastical assessment.

                        Signed:

                        Date: