Short Term Mission Chaplain Application Form Title * Name * First Name Last Name Name You Prefer to be known as (if not full first name) Date of Birth * MM DD YYYY Address Address 1 Address 2 City State/Province Zip/Postal Code Country Landline Phone Number (Please include IDD code if not UK) (###) ### #### Mobile Phone Number (Please include IDD code if not UK) (###) ### #### Email * Family Details Marital Status * Single Married Divorced Widowed Spouse's Name First Name Last Name Spouse's Date of Birth MM DD YYYY Names and Dates of Births of Children (One Per Line) Ministry Details Current Diocese * Current Appointment Date of most recent Leadership Safeguarding Training (C2 - C5) * MM DD YYYY Date of most recent DBS related to your current appointment * MM DD YYYY Number of most recent DBS related to your current appointment Date of Ordination/Licensing [Ordained Deacon or Licensed to Lay Ministry] * MM DD YYYY Theological College or Ministry Training Scheme Please provide scanned or photographed copies of documents supporting your answers in this section where possible by emailing them to jeperryman@ics-uk.org Have you any experience of ministry abroad? Yes No If YES, please give details ICS Involvement Are you familiar with any ICS Chaplaincies? * Yes No If YES, please give details Are you currently a financial supporter of ICS * Yes - Full Member Yes - Friend No - Please Send Details Does Your Church Support ICS? Yes No No - Please send details of ways we can do this Referees Two referees are required, who should know you in a ministry context. Please ask their permission first. Your Diocesan Bishop will also be approached for a ’safe to receive’ letter. Referee 1 - Title and Full Name * Referee 1 - Email Address (Preferred) or Postal Address * Referee 2 - Title and Full Name * Referee 2 - Email Address (Preferred) or Postal Address * Please confirm that you have read the following documents (links to these documents were on the previous webpage) * Thinking of a Short-term Chaplaincy as part of ICS Resort Mission? ICS Basis of Faith Having read the accompanying papers, and considering your strengths and style of ministry, please indicate why you are applying to serve as a volunteer ICS Resort Mission chaplain * DECLARATION - By submitting this application, I affirm the ICS Basis of Faith and declare that I will uphold the evangelical tradition and further the aims of ICS. If offered a chaplaincy, I would be happy to minister within such a tradition. I confirm that all details given above are accurate to the best of my knowledge and give my permission for them to be used as necessary to further this application. Thank you!
