CONFIDENTIAL

APPLICATION FORM

Application for the post of CANON PASTOR

SECTION 1

Title

Surname

Christian names

Address

Home telephone number

Mobile number

Confidential E-mail

Ordained deacon in the Diocese of In

(year)

Ordained priest in the Diocese of In

(year)

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PLEASE NOTE: All boxes on this form will expand as you type, please feel free to give
details and do not feel constrained by the spaces on the form.

SECTION 2 – PRESENT APPOINTMENT

What is your present appointment? Please give the date you started and provide details of
the ministry you have undertaken including a brief description of the responsibilities and any
particular achievements.

SECTION 3 – EDUCATION AND TRAINING

Please give details, with dates, most recent first

a) Further education (including theological college or course). Please give qualification

obtained with class if degree.

Further/ Higher education – From To Qualifications obtained (with subjects

college / course / university studied and classes awarded)
attended

b) Other professional / practical qualifications obtained e.g. teaching, social work, further
study.

Other professional / vocational From To Qualifications obtained (with subjects

qualifications – college/ university studied and classes awarded)
attended

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Please list membership of any professional organisations.

SECTION 4 - PRE-ORDINATION CAREER

Please provide details on any pre-ordination roles that you held, including leadership roles in
the church.

Position held and Brief description of responsibilities and Dates from and to
employer any particular achievements (including reason for
leaving)

SECTION 5 – MINISTRY SINCE ORDINATION

a) Posts held since ordination (full and part-time not including present appointment).

Please list these, with separate entries for posts held concurrently (e.g. rural dean,
chaplaincies etc). Please indicate major features of the role (e.g. type of area, team ministry,
ecumenical) and provide details of your ministry in each role and set out any particular
achievements. Please start with your most recent post and indicate your reason for leaving.

From To Post and description

b) Specialised Work

If over your ministry you have developed a specialist area of expertise (e.g. liturgy, mission,
social responsibility, ecumenism, interfaith etc.) please could you indicate this/these and
outline your work in the area(s) specified.

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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 learning / development activities undertaken eg
mentoring in the last 5 years. Please include courses and activities both inside and outside
the Church.

e) Publications

Title Date of Publisher Review references

publication

f) Theological and ecclesiological

What theological traditions have shaped your ministry and with which do you feel most at
ease today?

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g) What are your priorities in ministry?

SECTION 6 - 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?

Organisation Brief description of responsibilities and any Dates from and to

particular achievements

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?

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c) Other interests

Please indicate other recreational interests.

SECTION 7 – PERSONAL STATEMENT

Please state your reasons for applying for this post. What you write and how you write it
will help those making the appointment build up a picture of you. 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.

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SECTION 8 – CONFIDENTIAL

This section will be removed by the Head of HR and will only be made available to the
Chair of the selection event and the Archbishop.

If you are appointed to the post you will be asked to provide information about you and your
family so you can receive appropriate pastoral care.

References:

Please give names, occupations, contact numbers and e-mail addresses of three persons to
whom reference can be made. At least one should be clerical (not the bishop as their
reference is sought as a matter of course) and one from a senior lay person. Referees should
have a detailed up-to-date knowledge of your work. Please obtain their permission. If you
have oversight of other clergy, a church or community please ensure that one of the
referees can comment from this perspective. The reference request seek information on
various aspects of your ministry. It important that your referees experience your ministry
from different perspectives to enable a richer picture to develop.

Please indicate if referees may be contacted prior to interview: YES or NO [please delete]

Name:

Occupation:

Capacity in which
they have known
you

Address

Email address

Telephone number

Name:

Occupation:

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 Capacity in which
they have known
you

Address

Email address

Telephone number

Name:

Occupation:

Capacity in which
they have known
you

Address

Email address

Telephone number

We expect to take up references before the interview unless you have indicated otherwise.

Accessibility:

Please specify any supportive measures we can take to ensure you are able to fully
participate in the selection event e.g. mobility access, dietary requirements.

Start Date:
If appointed, approximately when would you be able to take up the role?

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SECTION 9 PROOF OF RIGHT TO WORK IN THE UK

Do you have the right to take up employment in the UK and are free to remain and work in the UK with no current
immigration restrictions?
(Please use an X) Yes No

SECTION 10 FURTHER APPLICATION INFORMATION

1. Are your papers available from the Clergy Appointments Adviser?

Yes No

2. Promoting racial equality

Are you a member or active supporter of the British National Party or any other political party or organization whose
constitution, policies, objectives or public statements are incompatible with the teaching of the Church of England in
relation to the equality of persons or groups of different races?
Yes No
3. Ecclesiastical Offices (Age Limits) Measure 1975
Appointment to an ecclesiastical office cannot be offered to anyone aged or over 70 except on a fixed or limited term
licence. Are you under the age of 70?

Yes No

The successful candidate will be required to have a clear enhanced barred list disclosure from the Disclosure and Barring
Service.

DECLARATION
I declare that, to the best of my knowledge, the information on this application is true. I understand that if the information
I have supplied is false or misleading in any way, I will automatically be disqualified from the appointment or dismissed
without notice.

Signature: Date:

NOTES:

It is important that this application form is completed by applicants. A Curriculum Vitae is not an acceptable substitute.
Please submit electronically to [email protected] by no later than 9.00am on Monday 28 November 2022.

Remember to use a Word not PDF format so that Sections 8 and 9 can be detached.

A confidential reference will also be requested from your diocesan bishop or area bishop in addition to other references. The
EU General Data Protection Regulations applies to all references and commendations.

The successful candidate will be required to receive an enhanced disclosure from Disclosure and Barring Service. The post will
be offered subject to the candidate accepting to hold office under Common Tenure.

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Travelling expenses and subsistence allowance (in accordance with General Synod regulations) will be allowed to candidates
selected for interview.

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