Communion of Evangelical Episcopal Churches Diocese of Endorsed Chaplains 902 Spring Valley Road, Altamonte Springs, Florida 32714 (407) 389-0314 Dear Friend Thank you for contacting us about your intrust in ministry an endorsed chaplain or pastoral councilor with the Communion of Evangelical Episcopal Churches, (CEEC). CEEC CEEC E S C Ecclesiastical Endorsement is commonly required by employers for ministry in specialized settings like the military, health care institutions and counseling practices. Endorsement is also a common requirement for professional certification. The Office of Endorsed Chaplains grants approval for the training and Ecclesiastical Endorsement to serve on the behalf of the CEEC. Chaplaincy and Pastoral Counseling supports the work of the Office and Diocese of Endorsed Chaplains. We have included, in this package, an application for endorsement along with other necessary documents. We look forward to receiving your application. Please consider the requirements of the organization you are seeking endorsement for before you submit the following forms.. Please include a letter indicating the endorsement or approval you are seeking. Let us know if you have any questions. Please note that the approval process takes several weeks from the date we receive your packet. Mail your application, forms and fees to; Office of Endorsed Chaplains 902 Spring Valley Road Altamonte Springs, Florida 32714 Our blessings are sent to you as you consider the leading of the Holy Spirit into this specialized work of ministry. Sincerely, Bishop David Scott Chief Endorser for the Communion of Evangelical Episcopal Churches Diocese of Endorsed Chaplains
Check endorsement credential(s) for which you are applying: ( ) Army ( ) Active Duty ( ) Navy ( ) Active Duty ( ) Air Force ( ) Active Duty ( ) Military Guard ( ) Military Reserves ( ) Military Seminarian ( ) Civil Air Patrol ( ) Veterans Affairs ( ) Civilian Healthcare ( ) Correctional ( ) Workplace ( ) Public School ( ) Professional Counselor ( ) Certified Volunteer ( ) Other: Application For Ecclesiastical Endorsement, Approval, or Certification For Appointment as Chaplain, or Chaplain Candidate, With The Communion of Evangelical Episcopal Churches In the Diocese of Endorsed Chaplains For Office Use Only Date Received College Transcripts Seminary Transcripts Essays Personal Testimony 2 Recent Photographs Statement of Understanding Code Of Ethics Background Afermation Statement of Authorization CEEC Identity Statement Copy of Ordination References Application Fee Office of Endorsed Chaplains 902 Spring Valley Road, Altamonte Springs, Florids 32714 (407) 389-0314 INSTRUCTIONS: Please print or type answers to all questions. If you need more space, please feel free to attach separate sheets. A. Personal Data 1. Name Date of Birth Soc. Sec. No. Last First Middle 2. E-mail Address E-mail Address 3. Home Address ( ) Street or Box City State Zip Telephone 4. Office Address ( ) Street or Box City State Zip Telephone 5. Are you an American citizen? (a) By Birth? (b) By naturalization? Give Date: 6. Height 7. Weight 8. Have you any physical defects? ( ) No ( ) Yes. If so, describe: 9. Do you have any disabilities? If so, briefly describe: 10. Have you ever been hospitalized for mental health concerns? ( ) No ( ) Yes. If so, please state the nature of illness(es): (Use the back or separate sheet of paper if necessary.) 11. Have you ever been charged with or convicted of a criminal offense? ( ) No ( ) Yes. If so, When? Where? Charges: 12. Have you ever committed a serious criminal act for which you were not charged? ( ) No ( ) Yes. Is so, When? What was it? 13. Have you ever filed bankruptcy or had any serious financial problems? ( ) No ( ) Yes. If so, what date? 14. What are your hobbies? 15. Describe athletic ability.
B. FAMILY AND MARITAL DATA 1. What is your marital status? If married, date of marriage 2. Spouse s name: 3. Are you and your spouse living together? ( ) Yes ( ) No 4. Do you or your spouse have a former marriage(s) or living companion? ( ) No ( ) Yes Please explain your history on a separate sheet of paper. Note: A divorce is not an automatic disqualifier. 5. To what extent does your spouse share/support your interest in pastoral care giving? 6. If you have children, list name and date of birth of each. Child 1. Name D.O.B. Age ( ) Male ( ) Female Child 2. Name D.O.B. Age ( ) Male ( ) Female Child 3. Name D.O.B. Age ( ) Male ( ) Female Child 4. Name D.O.B. Age ( ) Male ( ) Female 7. List permanent emergency address and telephone number. Address ( ) Street or Box City State Zip Telephone 8. List Someone other than yourself, who will always know your whereabouts Name First Last Relationship Address ( ) Street or Box City State Zip Telephone C. References Name First Reference Address, City, State, Zip Telephone & E-mail How Long Name Second Reference Address, City, State, Zip Telephone & E-mail How Long Name Third Reference Address, City, State, Zip Telephone & E-mail How Long
D. MINISTERIAL AND SPIRITUAL DATA 1. Date of Salvation: 3. Date Baptized: 2. Have you experienced the Baptism of the Holy Spirit: If so, when, 3. Please indicate your current ministerial status. ( ) Deacon ( ) Priest ( ) Bishop Other: 3. When were you Licensed? By whom? Tel. 4. When were you Ordained? By whom? Tel. 6. When were you Consecrated? By whom? Tel. 7. What is your church background: 8. Are you currently an Endorsed Chaplain? ( ) Yes ( ) No (Name of Endorsing Organization?) Name and Address of Current Endorsing Agent 9. If you are requesting a change from your current endorsing Organization/ Denomination please give a brief reason why. 9. Have you previously applied for approval or endorsement with the CEEC? ( ) Yes ( ) No What disposition was made of this previous application? 10. Full Time Ministerial Experience, Post Seminary, Post Ordination if any, beginning with the present and working back: (Use the back or separate sheet of paper if necessary.) 1. Church or Employer From: To: Position Held Address 2. Church or Employer From: To: Position Held Address 3. Church or Employer From: To: Position Held Address 4. Church or Employer From: To: Position Held Address
E. EDUCATIONAL DATA 1. College and Seminary training (please do not use initials for school names): (Use separate sheet of paper if necessary.) Name of College or Seminary Address, City, State, Zip ( ) Bachelor s degree; ( ) Master of Divinity; ( ) Master Degree in ; ( ) Doctors Degree in Total number of semester hours for degree checked. Years Attended From: To: Name of College or Seminary Address, City, State, Zip ( ) Bachelor s degree; ( ) Master of Divinity; ( ) Master Degree in ; ( ) Doctors Degree in Total number of semester hours for degree checked. Years Attended From: To: Name of College or Seminary Address, City, State, Zip ( ) Bachelor s degree; ( ) Master of Divinity; ( ) Master Degree in ; ( ) Doctors Degree in Total number of semester hours for degree checked. Years Attended From: To: Name of College or Seminary Address, City, State, Zip ( ) Bachelor s degree; ( ) Master of Divinity; ( ) Master Degree in ; ( ) Doctors Degree in Total number of semester hours for degree checked. Years Attended From: To: 2. Please send copies of all college and seminary transcripts (as applicable) to the Office of Endorsed Chaplains. 3. Have you had any Clinical Pastoral Education? ( ) Yes ( ) No If so, list be Quarter/Unit (Use the back or separate sheet of paper if necessary.) Location City State From: To: Location City State From: To: Location City State From: To: 4. Have you had any Supervised Pastoral Counseling? ( ) Yes ( ) No If so, list number of hours. (Use the back or separate sheet of paper if necessary.) Location City State From: To: Location City State From: To: Location City State From: To: 5. Other specialized training you have received (or certifications and memberships you hold) to prepare for chaplaincy:
F. DISCUSSION 1. Please discuss the following topics on additional paper: a. Why do you desire to serve as a chaplain? Please explain your call. b. How have you prepared, are you preparing, yourself for the chaplaincy? c. List, in order of priority, the major functions of a chaplain. d. Discuss controversial areas confronting the chaplaincy. e. What do you do most effectively as a minister? f. What do you do least effectively as a minister? g. Your concept of financial stewardship. h. Your understanding of pastoral care in a pluralistic setting. 2. Prepare a testimony of yourself (at least 200 words) and attach it to this application. STATEMENT OF UNDERSTANDING AND COMMITMENT: (Please be sure you read this carefully before signing. If you have any questions or concerns, please call.) 1. I understand that I must meet all the requirements for chaplains of the particular military service or civilian institution or chaplaincy membership organization to which I apply. All USA education must be appropriately accredited (regionally, ATS, or TRACCS). Foreign educational institutions will be evaluated on a case-by-case basis. 2. I understand and authorize that, because of the security requirements of the U.S. Armed Forces (military), and other institutions and organizations (civilian), I will be investigated for criminal and character backgrounds. 3. I understand that, if commissioned or appointed as a chaplain, I will be working with chaplains of other denominations and faith groups, sometimes differing widely with my own views and beliefs. While I will not be asked to compromise my own conscience and beliefs, it is essential, by the very nature of chaplaincy, that I consider their ordination and ministry as valid in the U. S. military or civilian institution as is my own. I understand that an attitude or practice of hostility and non-cooperation towards pastoral caregivers and adherents of other faiths will not be tolerated and is grounds for the immediate withdrawal of my endorsement credential. I have read and I agree to abide by the CEEC Identity Statement, Background Afermation and Statement of Authorization. Further, I realize that I must be willing to hold General Protestant worship services as well as those services specifically exercising all my own particular beliefs and practices. 4. I understand that it is a requirement of the Pentagon s Armed Forces Chaplains Board as well as civilian institutions and organizations that the CEEC have the authority to issue and withdraw endorsement credentials. 5. I understand that endorsement is a continuing requirement. Should I prove to be personally or professionally, or by other reason unsuited for the chaplaincy and should CEEC decide that my endorsement should be withdrawn, I agree to abide by its decision. Additionally, I understand that continuing education and professional development are essential for maintaining high quality pastoral caregiving. 6. I understand that CEEC is dependent on the financial support of chaplains, churches, and friends. I agree to regularly help with the expense of this ministry. (Generally, it is expected that professional chaplains will contribute 10% of their chaplaincy income, to support this ministry and, thus, safeguard the future of their ability to be responsibly endorsed.) Signature: Date: Permanent Address (if different than above) Home Address ( ) Street or Box City State Zip Telephone
BACKGROUND AFFIRMATION Preamble The Communion of Evangelical Epiacopal Churches (CEEC) thrir chaplains and pastoral counselors have an outstanding record as a group for maintaining the highest moral and ethical standards in the practice of their ministries. Recent court decisions have heightened the litigation risk for ecclesiastical endorsing agencies. Therefore, The Office of Endorsed Chaplains and the CEEC is committed to taking any reasonable precaution to avoid such suffering in the future and to meet its legal responsibilities. This Background Check Form is a part of the The Office of Endorsed Chaplains and the CEEC s effort to minimize the occurrence of improprieties among those clergy who are endorsed by the CEEC as military chaplains, institutional chaplains and pastoral counselors. Please complete the form with care. Your understanding and cooperation are deeply appreciated. 1. I have never been the subject of official disciplinary proceedings in The Communion of Evangelical Episcopal Churches, or in any ministerial or service organization that resulted in one or more of the following: a. growth program and/or counseling b. censure c. suspension of standing d. termination of standing 2. No official disciplinary proceedings by The Communion of Evangelical Episcopal Churches are pending against me at the present time. 3. I have never been the subject of official disciplinary proceedings by another denomination that resulted in disciplinary action. 4. No official disciplinary proceedings by another denomination are pending against me at the present time. 5. I have never been the subject of official disciplinary proceedings by a professional association or guild that resulted in disciplinary action. 6. No official disciplinary proceedings by a professional association or guild are pending against me at the present time. 7. No civil lawsuit alleging actual or attempted sexual discrimination, harassment, exploitation, or misconduct; physical abuse; child abuse; or financial misconduct has ever been successfully prosecuted against me, settled out of court, or dropped because the statute of limitations had expired. 8. My driver s license has never been suspended or revoked due to reckless driving, driving while intoxicated, or driving under the influence of controlled substances. 9. I have never been found guilty or pled guilty or pled no contest to felony criminal charges or had felony criminal charges dropped because the statute of limitations had expired. 10. My employment has never been terminated for actual or attempted sexual discrimination, harassment, exploitation, or misconduct; physical abuse; child abuse; or financial misconduct by me; nor have I terminated my employment primarily to avoid facing such charges or to avoid being terminated because of such charges. 11. I know of no facts or circumstances regarding my background that would warrant further review of my fitness for ministry before my being entrusted with the responsibilities of ministry on behalf of the The Communion of Evangelical Episcopal Churches.
Please provide a short explanation for each complaint, proceeding, or action that caused you to answer not true. Give enough information for follow-up, including the date, nature, and place of each incident leading to a complaint, proceeding, or action; where and when each was adjudicated; and the disposition of the complaint(s). Indicate steps taken toward rehabilitation, if any. Use additional pages as needed. 12. In addition to the names used on this form, as an adult, I have been known by the following name(s) during the time(s) indicated: I certify that the information is true to the best of my knowledge. I understand that The Diocese of Endorsed Chaplains will be relying upon this information to grant me approval or endorsement and I acknowledge that any significant and material misstatements may be used as a reason to deny, reconsider or revoke such approval or endorsement. 13 Please list on the reverse side of this page list all the addresses (including street, city, state, and zip) and time-frames where you have resided for any period greater than thirty days for the past fifteen years. You may use additional sheets if necessary. Should any of my responses to these statements change, I will immediately notify the Office of Endorsed Chaplains at (407) 389-0314, 902 Spring Valley Road, Altamonte Springs, Florida 32714. Signature Name Address Date Tel. & E-Mail
Statement of Authorization THIS FORM MUST BE COMPLETED BY ALL WHO APPLY FOR OR HOLD ECCLESIASTICAL ENDORSEMENT OR RECOGNITION FROM THE COMMUNION OF EVANGELICAL EPISCOPAL (Please type or print legibly) Name Street City State Zip Telephone Social Security Number Date of Birth * * * * * * * * * * * No application for ecclesiastical endorsement, recognition, or re-endorsement will be processed without this completed, signed, and dated document. By my signature, I authorize Communion of Evangelical Episcopal Churches and their designated investigating agency to conduct a personal and criminal background check on me. I understand that any negative report may result in the cessation of the endorsement process. I further understand and agree that if I am ever charged with, accused of, investigated for, moved because of, or transferred to another position because of alleged criminal and/or sexual and/or ethical misconduct that this document authorizes my employer or volunteer chaplaincy organization to release this information to The Communion of Evangelical Episcopal Churches and its Office of Endorsed Chaplains. Signed: Date: Please be sure you read this carefully before signing. If you have any questions or concerns, please wright or call 902 Spring Valley Road, Altamonte Springs, Florida 32714 (407) 389-0314 I have enclosed a $100.00 check to help defray the costs of my personal and criminal background investigation. (Initial your response ) NO YES
CEEC IDENTITY STATEMENT AND DOCTRINAL ESSENTIALS. 1) The CEEC defines Anglicanism as English Orthodoxy, developing from the very beginning of the Christian faith in the British Isles and enduring to the present age. Therefore, in our usage, Anglicanism is inclusive of its Celtic origins, Patristic roots, the Medieval Church, the Protestant Reformation, the Wesleyan Evangelical Revival, the Oxford Movement, and the modern Charismatic movement. We measure Anglican history not only from Thomas Cranmer forward, but also from the Reformation backward. Anglicanism in the CEEC is not shaped by its connection to the See of Canterbury, but by its relationship to history. 2) The elements of Anglicanism are: a) The priority and authority of Holy Scripture as the source of our knowledge of God; b) The doctrinal guidance of the Catholic Creeds: Apostle s, Nicene, and Athanasian; c) The truth that salvation is, in the final analysis, the gift of God and by grace alone; d) The use of liturgy which is faithful to Scripture and embodies the experience of the church in worship over the centuries; e) The historic episcopate, or the order of bishops, as a sign of the unity of the one Church of God; f) The threefold ministry of bishop, presbyter (priest), and deacon as that ministry which God has led the Church to adopt since primitive times; g) The two Gospel sacraments of Holy Baptism and Holy Communion ordained by Christ for regular use in the Church; h) The unity of the ministry of the Word and Sacrament in the Service of Holy Communion; i) The need for regular preaching and teaching from the Holy Scriptures; j) The recognition that the visible unity of the Church on earth is God s will; k) The need for a regularly reviewed Canon Law, to respond to the unfolding needs of the people and the church; l) The priesthood of the whole church as a worshiping and praying society m) The recognition of the continuing ministry of the Holy Spirit and the impartation of gifts and min istries in our time; n) A commitment to fulfill The Great Commission to winning the world to Jesus Christ into the Third Millennium; 3) The Communion s approach to liturgy and worship is not based on legislative but normative practice as defined by the Scriptures, the Book of Common Prayer, and the historic practice of the Church. 4) We anticipate liturgical practice to be expressed in three broad categories; low or Evangelical Ch- Venn Diagramurch, broad Church, high or Anglo-Catholic Church. The practice of a local congregation is recognized and determined by its relationship to its bishop. Signed: Date: Please be sure you read this carefully before signing. If you have any questions or concerns, please wright or call 902 Spring Valley Road, Altamonte Springs, Florida 32714 (407) 389-0314
Diocese of Endorsed Chaplains Code of Ethics Preamble The Diocese of Endorsed Chaplains Code of Ethics is designed to edify the body of Christ. We pray it will be embraced by all members of The Diocese of Endorsed Chaplains, hereafter referred to as, DoEC, serving in any and all the Avenues of our ministry. The code is intended to be a living document that helps shape our character as we constantly seek to make it better reflect Christ s will for us as ordained ministers in His Church. Ethics provides a framework for how people make decisions and judgments and how we act on them. Decision making for the Christian is ethical when it is firmly grounded in the Word of God and led by the Holy Spirit, for it is only in these that we find a basis for understanding the will of God. As Christians, we must submit ourselves to the Word of God and allow the Holy Spirit to guide us in the application of ethical principles of Scripture. Our Christian conduct must be based on the life and teachings of Jesus, the teachings of biblical writers and the guidance of the Holy Spirit. The New Testament calls for the highest standard of reputation, ethics and conduct for us as servants of God. As members of DoEC, we recognize that Jesus Christ lives in us through the Holy Spirit. We ask him to change us so that the reality of his resurrected life is evident in our thoughts and actions. The ethical guidelines and principles in The Canonical Order of Chaplains Code of Ethics are set forth to tie in the realities of our pastoral activities with this transcendent reality of our Christian lives. Therefore, as ministers in the body of Christ, we must endeavour to conduct our lives according to the spirit of the ethical guidelines and principles set forth in The Diocese of Endorsed Chaplains Code of Ethics.
Responsibility to God Knowing that Jesus Christ is the living Head of the Church, I will strive to conduct myself in a manner that brings glory to him. This means I will strive to: a. Be a responsible servant of God. b. Exercise faithful stewardship in my keeping hours of prayers and devotional life through the use of spiritual disciplines, c. Accept accountability for all my actions and avoid situations that could reflect negatively on the name of Jesus Christ. d. Maintain sexual purity. e. Exercise Christ s example of servant-leadership. f. I will show my personal love for God as revealed in Jesus Christ in my life and ministry, as I strive together with my colleagues to preserve dignity, and maintain personal discipline and promote the integrity of the vocation to which we have been called. Responsibility To Family I will place my family responsibilities at the highest level of my priorities, second only to my relationship to God. This means I will strive to: a. Spiritually, emotionally and physically support my family. b. Be faithful to my spouse. c. Be a responsible and dedicated parent to my children. Responsibility to The CEEC. As a member of DoEC, I have a responsibility of loyalty to this community of servants and the apostolic leadership of the Episcopal Leadership of the Communion. This means I will strive to: a. Patiently and prayerfully study all doctrinal materials presented by the The CEEC. b. Support and carry out all decisions taking by the International House of Bishops as well as the diocese and the bishop ordinary. If I cannot in good conscience do this, I will immediately notify my bishop. c. Cooperate with, and seek assistance from, my bishop, my peers in the periodic review of my ministerial gifts and practices. d. Respect The CEEC and be responsible and respectful in discussions about fellow leaders past and present. e. Support and promote the worldwide mission of The CEEC. Responsibility To The Diocese of Endorsed Chaplains. I will lead with justice and mercy, striving to express proper balance between strength and gentleness in all situations. This means I will strive to: a. Provide sound and clear pastoral, spiritual leadership. b. Help fellow clergy members to develop spiritual gifts and mentor spiritual leaders in the congregation.
c. Give teachings and council that are biblically based, in theological agreement with The CEEC and are relevant to the life of the church. d. Be committed to prompt reconciliation of interpersonal conflicts. I recognize that I must have personal courage, exercised with appropriate tact in facing opposition. I will encourage members of The DoEC to seek help from my peers and/or ecclesiastical supervisors if necessary. e. Be fair and consistent in my dealings with parishioners. f. Honor and respect all cultures, genders and races. Responsibility To My Colleagues. As a member of The DoEC, I have a responsibility to respect and honor my colleagues. I will strive to cooperate with and support my fellow ministers as we work together to further the work of Christ in The DoEC and the Church. This means I will strive to: a. Respect my fellow ministers and will not speak against them publicly or privately, considering them partners in the work of God. b. Respect the work of others ministers and their responsibility. c. Treat The Office of Endorsed Chaplains in a manner so as not to be competitive or derisive. d. Serve my colleagues with counsel, support and personal assistance. e. Be trustworthy in all areas of confidentiality towards my colleagues, except as I am legally bound to disclose. I will not betray the trust of a colleague by disclosing personal information about that person to others without that person s knowledge and consent. Responsibility To The Those I Serve As a member of The DoEC I have the responsibility to respect the greater Christian community, Body of Christ, and those I serve as an Endorsed Chaplain. This means I will strive to: a. Promote unity in all aspects of my ministry. b. Build bridges of communication and understanding with the greater Christian communities leadership. c. I will help laypersons and colleagues to understand that ministerial leaders should not expect or require fees for pastoral services from constituents they serve. d. I will not seek personal favors or discounts on the basis of my ministerial status. e. I will not proselytize from other Christian churches. f. I will hold in confidence and treat as confidential any communication or information provided to me, except as I am legally bound to disclose. I will not disclose such information in private or public except when, in my practice of ministry, I am convinced that the sanctity of confidentiality is outweighed by my well-founded belief that life-threatening or substantial harm will be caused.
g. I will not use my ministerial status, position or authority knowingly to abuse, misguide, negatively influence, manipulate, or take advantage of anyone, especially children. h. I will report all instances of abuse as required by law to the appropriate agency. I will also report the circumstances to the appropriate regional and/or national denominational representative. I attest that I have fully read and understand the Ethics Statement above and am in agreement with them and I am willing to submit to their discipline. Signature of Applicant Date