Hidden Fields





Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Church Account Prefill


Logo

Confidential Screening Questionnaire

NON-MINISTRY ROLE APPLICANT

Confidential Safe Ministry Check Questionnaire

Ordained Ministry, Appointment as a Paid, Licensed or Authorised Church Worker








SECTION 1
THE SAFE MINISTRY CHECK

mini Logo

To you, the Applicant

The Anglican Church of Australia has established standards of conduct for clergy and church workers to maintain a safe and healthy ministry environment. The Anglican Diocese of Tasmania adheres to these standards.


Our commitment to these standards requires that we conduct background referencing for all persons who intend to engage in ordained and lay ministry in Australia.  This request for information is being made to comply with Anglican Church of Australia policies, and not because we have any reason to believe that any applicant has in fact engaged in inappropriate conduct.


As part of our screening process, we request you to answer a series of questions which are, of necessity, intimate in nature.  If you do not understand the question or would like to discuss your answer further, please feel free to call the Director of Professional Standards on 6220 2025 or the Safe Church Communities Coordinator on 6220 2020.

Completing the Form

1. Before completing this document read Faithfulness in Service, which includes the code of conduct for safe ministry to children. You can find Faithfulness in Service on the Diocesan website under Quick Links – Code of Conduct.


2. The Safe Ministry Check takes the form of a Statutory Declaration. It is a criminal offence to make a Statutory Declaration knowing it to be untrue in any material way.


3. You must answer all questions. Where required, select the appropriate box.

If you answer ‘Yes’ to a question please add additional information in the space provided.


   Please note:

  •  a ‘Yes’ answer to a question will not automatically rule an applicant out of selection; and
  •  we do not interpret a ‘Yes’ answer to a question as a charge of professional misconduct.  The Diocese has a formal process for making such a charge.

4. Click SUBMIT. You will receive instructions for your e-signature via email. Follow these emails. 


5.  You will also received an email with an attached PDF. Print the PDF. On the printed copy of your PDF, sign the declaration and ensure that your signature is witnessed by a person authorised to witness a Statutory Declaration.


6. Scan and send to psu@anglicantas.org.au or post addressed to Confidential to the Professional Standards Unit, Anglican Diocese of Tasmania, GPO Box 748, Hobart, Tasmania 7001. 

Privacy Statement

Your privacy is important to the Anglican Diocese of Tasmania. Only information relevant to the purpose of this form is collected. Your details are held in a secure system and not made available to others unless it is legally required to do so. For further details please read the Privacy Policy available at www.anglicantas.org.au. Your form will be stored digitally and paper copy will be shredded.

Interview

The Diocese of Tasmania conducts Safe Ministry Check Questionnaire interviews to enable discussion of the questions in this form and of your responses. You will be advised if this is required for the position for which you have applied. If you attend a Safe Ministry Check Questionnaire interview, please bring for Proof of Identity one (1) document, which includes a recent photograph either a Passport, current Driver’s Licence or WwVP.





SECTION 1
THE SCREENING CHECK QUESTIONNAIRE

mini Logo

To you, the Applicant
Thank you for applying for a position in the Anglican Diocese of Tasmania.

The Anglican church is committed to doing everything we can to ensure that churches and organisations are safe places for all who participate in our activities – including children, people with disabilities, the aged, and our employees.

This is why everyone who participates in any type of ministry or employment is screened and helps to ensure that the Diocese provides a safe place for all. 

About this Form
This form is part of your assessment process for employment in the Diocese of Tasmania.

Your answers are confidential and are only accessed by the Professional Standards Unit and then stored securely.

You are asked to provide referees who will share their understanding of your suitability for the role for which you have applied.

Completing the Form

1. Please read and complete ALL sections of this form.


2. You must answer all questions. Where required, select the appropriate box.

If you answer ‘Yes’ to a question please add additional information in the space provided.


   Please note:

  •  a ‘Yes’ answer to a question will not automatically rule an applicant out of selection.

3. Click SUBMIT. You will receive instructions for your e-signature via email. Follow these emails. 


4.  You will also received an email with an attached PDF for your personal records.

Privacy Statement

Your privacy is important to the Anglican Diocese of Tasmania. Only information relevant to the purpose of this form is collected. Your details are held in a secure system and not made available to others unless it is legally required to do so. For further details please read the Privacy Policy available at www.anglicantas.org.au. Your form will be stored digitally and paper copy will be shredded.




SECTION 2
YOUR DETAILS

mini Logo
2.1 Personal details















Have you been a resident in any other Australian State or Territory, or in another country?
Please list all previous interstate or international address, the most recent first.



If you do not know the exact dates, put the 1st of the month when you first commenced and when you finished, e.g. 01/12/2020.




This email will be used for all communications to you including your private documents.
2.2 Confirming your identity





2.2 Confirming your identity


2.3 Working with Vulnerable People Card Details




2.4 Record of Ordination/Consecration
Yes No
2.5 Record of Bishop's Licences or Authorities
Yes No
Please provide details below, the most recent first.





If you do not know the exact dates, put the 1st of the month when you first commenced and when you finished, e.g. 01/12/2020.
2.6 Record of Christian Church Membership and Christian Ministry
Complete the table below regarding any church you have attended regularly during your adult life, excluding positions detailed above. List the most recent first.





If you do not know the exact dates, put the 1st of the month when you first commenced and when you finished, e.g. 01/12/2020.
2.7 Record of past employment
Please provide your employment history for the last 15 years below, with the most recent first.





If you do not know the exact dates, put the 1st of the month when you first commenced and when you finished, e.g. 01/12/2020.




SECTION 3
SUITABILITY FOR MINISTRY

mini Logo

3.1 Identity
Yes No

3.2 Health and social issues
Yes No


3.3 Criminal and other offences
Yes No
c. This question relates to action before a licensing board, professional association, community association, sports club, employer, educational institution, church or any other body.
Yes No


3.4 Licences/authorities
Yes No






3.5 Employment and professional conduct
Yes No


3.6 Financial matters
Yes No


3.7 Abusive conduct
Yes No

‘Child abuse’ means:

  • the following conduct in relation to a child:
    bullying; emotional abuse; harassment; neglect; physical abuse; sexual abuse; spiritual abuse; grooming; or
    the failure without reasonable excuse to comply with the laws of the Commonwealth, a State or Territory requiring the reporting of child abuse to the police or other authority; or
  • the possession, production or distribution of child exploitation material.

The context of the conduct includes personally, virtually or by any electronic means.



3.8 Sexual conduct and misconduct
Yes No

‘Sexual conduct’ includes sexually motivated touch and conversation through to sexual intercourse of any kind.
The context of the conduct includes personally, virtually or by any electronic means.

Yes No

‘Sexual misconduct’ includes:

  • abuse of power or role for sexual purposes
  • sexual conduct with a person under the age of consent or with an adult not competent to give consent
  • sexual assault (e.g. rape)
  • soliciting for sexual purposes

Yes No

  • sexual contact with a parishioner, client, patient, student, employee or subordinate (other than with your spouse)
  • sexual contact with a person under the age of consent
  • illegal use, production, sale or distribution of child exploitation material
  • conduct likely to cause harm to a child or young person, or to put them at risk of harm



3.9 Personal Behaviour
Yes No




SECTION 4
CHARACTER REFERENCES

mini Logo
Please provide details below of three (3) referees. Referees must be over eighteen years of age and be able to give a report on your good character and suitability for ministry among children and young people. They must NOT be a relative, close friend or a member of the Selection panel. If you have lived in another state or country, please include a referee from your last parish or organisation in that state and/or country.

We will contact your referees by email, please ensure mail address is current if referee has no email.
Note: Three (3) referees are required

For REFEREE 1: This person must be a Senior Church Leader, e.g. Bishop, Archdeacon, rector, church warden, elder.
For REFEREE 2: This person must be one of the following: a current or former employer, current or former supervisor or authorised person in a para-church or other organisation in which you have worked or served in an honorary or volunteer capacity, or if you have no employment or volunteer history, a current or former teacher.
For REFEREE 3: This person must be someone who knows you well, having known you for at least three years.















SECTION 5
STATEMENTS

mini Logo

Authority for information
I understand that it is the policy of the Anglican Church of Australia to ask:
          •  Those who serve or have served as my bishop or equivalent

• Churches I have regularly attended as an adult and

• my employers

whether to the best of their knowledge I have engaged in specified conduct that is relevant to the assessment of whether I am a suitable person to undertake ministry in the Church.

I have identified all positions in which I have held a bishop’s licence or authority or equivalent, all churches which I have regularly attended as an adult and my employers.  I hereby authorise the Anglican Church and its delegates to contact and exchange information with them.

I further hereby authorise every one of those bishops, churches and employers to inform the Anglican Church and its delegates of any knowledge they may have relevant to the assessment of whether I am a suitable person for to undertake ministry in the Church.

I hereby authorise my referees to answer the Referee’s Screening Questionnaire and to provide any information relevant to my application to you and your delegates.

Release from liability
I hereby release from liability any person or organisation that provides information relevant to the assessment of my suitability to undertake ministry in the Church.

I also agree to release the Anglican Church and its delegates from any and all liability as it relates to any investigation by them regarding the information contained in this application, or any action by them as a result of such investigation
Acknowledgement
I understand that any material misstatement in or omission from this questionnaire may render me unfit to hold a particular or any office in the Church or to remain in employment in a Church body







SECTION 6
STATUTORY DECLARATION

mini Logo
When you have submitted this online application, you will receive a PDF of your application. You will need to print out this PDF and have this signed in-person by yourself and a witness.
Your signature must be witnessed by a person authorised in this jurisdiction to witness a Statutory Declaration. The witness is not required to read the document.

Declaration by the applicant                                                        
I,  (applicant name) __________________________________________________________ 


of ___________________________________________________________________________

do solemnly and sincerely declare that the information I have provided in this application and the information contained in any documents accompanying this application are true and correct to the best of my knowledge and belief.


Declared at (address):________________________________________________________

Declaration Date (DD/MM/YYYY):  ____________________________________________

Witness full name: ___________________________________________________________________

Witness address: _____________________________________________________________________

Thankyou note




SECTION 3
SCREENING QUESTIONS

mini Logo

3.1 Health and social aspects
Yes No

3.2 Criminal and other offences
Yes No

‘Charged’ means that the police or other government authority has accused you in writing of committing a criminal offence. (Traffic infringement notice does not need to be declared.)

Yes No

3.3 Licenses/authorities
Yes No
Yes No

3.4 Respectful conduct
Yes No

A child is a person under the age of 18. Child abuse means:

  • Doing any one or more of the following things to a child, whether directly in person or via an electronic device such as a computer, tablet or phone: bullying; emotional abuse; harassment; neglect; physical abuse; sexual assault; spiritual abuse; grooming; or
  • Failing – without a reasonable excuse – to comply with any law that requires you to report child abuse to the police or other authority; or
  • Possessing, producing, or distributing child exploitation material (e.g. viewing child pornography or sexting)

Yes No

  • Conduct likely to cause harm to a child or young person, or to put them at risk of harm; or
  • Failing – without a reasonable excuse – to comply with any law that requires you to report child abuse to the police or other authority; or
  • Possessing, producing, or distributing child exploitation material (e.g. viewing child pornography or sexting)
  • Production, sale, distribution, or illegal use of child exploitation material.


3.5 Sexual conduct
Yes No

3.6 Financial and resource integrity
Yes No

3.7 Additional comments




SECTION 4
RECORD OF EMPLOYMENT AND VOLUNTEER ACTIVITY

mini Logo
Please provide your employment history below, with the most recent first.
Yes No




if you do not know the exact day, please put the 1st of the month when you started e.g. 01/12/2021

if you do not know the exact day, please put the 1st of the month when you ended e.g. 01/12/2021
If you do not know the exact dates, put the 1st of the month when you first commenced and when you finished, e.g. 01/12/2020.




SECTION 5
CHARACTER REFERENCE

mini Logo
Please provide details below of three (3) referees. In this context, a ‘referee’ is someone over 18 years of age who has known you for a minimum of one year and who can give a report on your good character and suitability for employment or appointment in a position in this organisation. A referee cannot be a relative or a close friend.

We will contact your referees by phone or email. If you have lived in another state or country within the last three years, please nominate at least one referee from your most recent employer or organisation in that state or country.
Note: Three (3) referees are required

For REFEREE 1: This person must be an employer or volunteer work supervisor or similar.
For REFEREE 2: This person might be an employer or volunteer work supervisor or similar.
For REFEREE 3: This person might be an employer or volunteer work supervisor or similar.
















SECTION 6
STATEMENTS

mini Logo
Authority for information
I hereby authorise:

• The Anglican Diocese of Tasmania and its delegates to contact and exchange information with the employers and organisations in the section Record of Employment and Volunteer Activity.

• Every one of these bodies to provide to the Anglican Diocese of Tasmania and its delegates any information they may have that is relevant to assessing whether I am a suitable person to undertake employment in the Diocese; and

• My referees to provide to the Anglican Diocese of Tasmania and its delegates any information relevant to my application for appointment as a church body employee.

Release from liability
I hereby release from liability any person or organisation that provides information relevant to the assessment of my suitability to undertake employment in the Anglican Diocese of Tasmania.

I also agree to release the Anglican Diocese of Tasmania and its delegates from any and all liability as it relates to any investigation by them regarding the information contained in this application, or any action by them as a result of such investigation
Acknowledgement
I understand that any intentional error or omission in the information in this application may prevent me from undertaking employment in the Anglican Diocese of Tasmania.

Declaration by the applicant                                                        
do solemnly and sincerely declare that the information I have provided in this application and the information contained in any documents accompanying this application are true and correct to the best of my knowledge and belief.

Thankyou note

Logo-white