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Confidential Safe Ministry Check Questionnaire

APPLICATION FOR APPOINTMENT AS A VOLUNTARY CHURCH WORKER AGED 16 TO 17 YEARS

Confidential Safe Ministry Check Questionnaire

APPLICATION FOR APPOINTMENT AS A VOLUNTARY CHURCH WORKER AGED 18 YEARS AND OVER

First Name

Surname

Parish or Organization

What will you be doing?

Today's Date (dd/mm/yyyy)

*This application is valid for 3 months from this date.

SECTION 1
THE SAFE MINISTRY CHECK

To you, the Applicant

Thank you for volunteering to be involved in ministry 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 you, a volunteer.

This is why everyone who participates in any type of ministry is asked to meet specific standards of personal and public conduct, and to be screened. This ensures that our churches are safe places for all.

Standards for suitable behaviour and the screening of church volunteers are explained in the Faithfulness in Service document and the Safe Church Communities Ordinance. The questions in this form are based on these documents and the Volunteer Safe Ministry Check of the Anglican Church of Australia, Safe Ministry to Children Canon 2017.

Your time to complete this form is appreciated. Thank you once again.

The Rt Revd Dr Richard Condie

Bishop of Tasmania

About this Form

This form is a screening document that is part of your assessment process for Safe Church Communities endorsement to participate in volunteer ministry. It helps to determine your suitability. Your minister will be advised of the outcome of the process.

You are asked to answer several questions, some of which are personal and sensitive. If any question raises an issue for you, please seek help from a trusted friend or from the contacts below.

For help to complete this form: Safe Church Communities Coordinator - Ph: 03 6220 2020

For Pastoral Support: Please contact your minister

To make a complaint about abuse: Director of Professional Standards - Ph: 1800 017 286

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

You are asked to provide referees who will share their understanding of your suitability for volunteering within your church or organisation.

SECTION 1
THE SAFE MINISTRY CHECK

To you, the Applicant

Thank you for volunteering to be a junior team member in ministry 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 you, a volunteer.

Standards for suitable behaviour and the screening of church volunteers are explained in the Faithfulness in Service document and the Safe Church Communities Ordinance. The questions in this form are based on these documents and the Volunteer Safe Ministry Check of the Anglican Church of Australia, Safe Ministry to Children Canon 2017.

Your time to complete this form is appreciated. Thank you once again.

The Rt Revd Dr Richard Condie

Bishop of Tasmania

About this Form

This form is a screening document that is part of your assessment process for Safe Church Communities endorsement to participate in volunteer ministry. It helps to determine your suitability. Your minister will be advised of the outcome of the process.

You are asked to answer several questions, some of which are personal and sensitive. If any question raises an issue for you, please seek help from a trusted friend or from the contacts below.

For help to complete this form: Safe Church Communities Coordinator - Ph: 03 6220 2020

For Pastoral Support: Please contact your minister

To make a complaint about abuse: Director of Professional Standards - Ph: 1800 017 286

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

You are asked to provide referees who will share their understanding of your suitability for volunteering within your church or organisation.

Completing the Form

Please read and complete ALL sections of this form.

Answer honestly by checking the appropriate box.

A yes answer does not mean that you can’t be a volunteer, however we may wish to chat with you. If you answer yes, please supply details in the space provided. You can add further information on the Additional Comments section.

If you are not sure what is meant by a word or phrase in bold print, please consult the Key Terms in Faithfulness in Service (Code of Conduct) available on the Diocesan website.

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. Your form will be stored digitally.

SECTION 2
YOUR DETAILS

2.1 Personal details of person applying to be a Volunteer Church Worker

Title

Enter preferred title

Legal Name/s

Legal Surname

Previous Name/s

Also Known as:

Date of birth (dd/mm/yyyy)

Gender

Current occupation

Street address

Suburb

State

Postcode

Country

Home phone

Mobile phone

Work phone

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

2.2 Confirming your identity

Please attach to this form (or your email) a clear copy of ONE of the following:

Your current Australian State or Territory driver’s license OR learner's permit.Your birth certificate; a current Australian passport; an Australian citizenship document or Australian immigration papers.A current student identity card from an educational institution or equivalent form of identification.A Tasmanian Personal Information Card.I will send through my proof of ID at a later date.

Upload your Proof of Identity below

2.3 Working with Vulnerable People Card Details

Working with Vulnerable People Card?

Name on Card	Card Number
Expiry (dd/mm/yyyy)	Upload your WwVP Card

SECTION 3
SCREENING QUESTIONS

3.1 Health and social aspects

	Yes	No
a. Do you have any physical or mental health conditions which need to be taken into consideration for your involvement in programs with children or young people, vulnerable people, or people generally?
b. Do you currently abuse or have a heavy consumption of alcohol, or abuse other substances?
c. Does your current use of alcohol or mind altering or addictive substances adversely affect or impair your ministry, personal well being or relationships?
d. Do you have a history of substance abuse?

Substance abuse would include, but not be limited to abuse of prescription, over-the-counter, recreational or illegal drugs, use of mind altering substances and petrol sniffing.

	Yes	No
a. Do you have any physical or mental health conditions which need to be taken into consideration for your involvement in programs with children or young people, vulnerable people, or people generally?
b. Does your current use of alcohol or mind altering or addictive substances adversely affect or impair your ministry, personal well being or relationships?
c. Have you ever used illegal drugs?

3.1 Details for any YES answers above (provide question reference):

3.2 Criminal and other offences

	Yes	No
a. Have you ever been charged with a criminal offence in Australia or any other country?

‘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
b. Have you ever been convicted of a criminal offence in Australia or any other country?
c. Has anyone in Australia or in any other country alleged to a court, disciplinary tribunal or employer that you have committed a criminal offence?

3.2 Details for any YES answers above (provide question reference):

3.3 Licenses/authorities

	Yes	No
a. Have you ever had a driver’s license, or learner’s permit, whether in Australia or in another country revoked or suspended?

	Yes	No
b. Have you ever applied for a Working with Vulnerable People Check or a Working with Children Check in any State or Territory?
c. Did the authority to which you applied refuse to issue the check?
d. Has your Working with Vulnerable People Check or a Working with Children Check ever been cancelled, revoked or suspended?

	Yes	No
b. Have you ever applied for a Working with Vulnerable People Check or a Working with Children Check in any State or Territory?
c. Did the authority to which you applied refuse to issue the check?
d. Has your Working with Vulnerable People Check or a Working with Children Check ever been cancelled, revoked or suspended?

3.3 Details for any YES answers above (provide question reference):

3.4 Respectful conduct

	Yes	No
(not needed) b. Have you ever had a court order issued against you because of someone accusing you of violence, abuse, likely and/or threats of harm, harassment, or stalking? (E.g. An Apprehended Violence Order)

Respect for all

	Yes	No
a. Has anyone ever made a formal complaint about you bullying them? (E.g. Communicating in an abusive manner, behaving threateningly or inappropriately or making derogatory comments)
a. Have you ever had a formal complaint made about you bullying others?(E.g. Communicating in an abusive manner, behaving threateningly or inappropriately or making derogatory comments)
b. Has anyone ever made a formal complaint about you using your spiritual views to control the behaviour of others?
b. Have you ever had a complaint made about you pushing your beliefs about God on others to control their behaviour or beliefs?
c. Have you ever had a court order issued against you because of someone accusing you of violence, abuse, threats of harm or likely threats of harm, harassment, or stalking ? (E.g. An Apprehended Violence Order.)

	Yes	No
d. Have you ever engaged in sexting?

Sexting means requesting, sharing, sending or posting online explicit sexual picture, messages or videos.

	Yes	No
d. Have you ever engaged in sexual contact, other than with your spouse, whether personally, virtually or by any electronic means with a parishioner, client, patient, student, employee, or subordinate?
e. Do you currently or regularly view, produce or distribute pornographic or sexually explicit materials?

Respect for children

	Yes	No
f. Have you ever done anything that could result in someone accusing you of child abuse?

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

Harassment, physical bullying, verbal bullying, and cyber-bullying.

Touching a child in a sexual way without their consent.

	Yes	No
f. Has anyone ever accused you of child abuse?

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
g. Have you ever done anything that may result in someone accusing you of child abuse?
g. Have you ever produced sexual images of another person under the age of 18?
h. Has a child or dependent young person for whom you were caring as a parent or in any other capacity ever been removed from your care, or been subject of a risk assessment by the relevant authorities?
i. Have you ever engaged in any of the following conduct in any way (personally, virtually or by any electronic means)?

Conduct likely to cause harm to a child or young person, or to put them at risk of harm; or

Sexual contact with a person under the age of consent; or

Production, sale, distribution, or illegal use of child exploitation material.

3.4 Details for any YES answers above (provide question reference):

3.5 Financial and resource integrity

	Yes	No
a. Have you ever been accused of not following organisational procedures for the handling of finances (including cash) and/or resources/property?

3.5 Details for any YES answers above (provide question reference):

3.6 Additional comments

Additional details for any YES answers above (provide number):

SECTION 4
RECORD OF MINISTRY AND COMMUNITY ROLES

In the table below, please list all churches, parishes or congregations, and, if appropriate, church and para-church and community organisations (such as Scripture Union groups, Scouts, Guides, sport) where you have undertaken a role as a paid/voluntary worker. We will ask you to authorise them to tell us what they know that’s relevant to our assessment of your suitability for ministry in the church, if we choose to contact them.

	Yes	No
Have any of these been outside Tasmania?

To add another record/role, please click Add another response at the bottom of this box.

Church / Denomination / Organisation

Location & State

Role

From (dd/mm/yyyy)

To (dd/mm/yyyy)

*If you do not know the exact dates, put the 1st of the month when you first commenced and when you finished, eg. 01/12/2021.

SECTION 5
CHARACTER REFERENCE

Please provide details below of two (2) referees. In this context, a ‘referee’ is someone over 18 years of age who can give a report on your good character and suitability for ministry among children and vulnerable people. A referee cannot be a relative or a close friend.
If you have lived in another state or country within the last three years, please nominate at least one referee from your most recent parish or organisation in that state or country.

Please advise your referees that you have nominated them on this form and their prompt response will be appreciated.

We will contact your referees by email, please ensure mail address is current if referee has no email

For REFEREE 1: This person should be a senior church ministry leader in your current parish, preferably your rector, or an associate or youth minister.

For REFEREE 1: This person must be a church leader, such as a rector, church warden, parish councillor or youth minister, or other responsible person.

For REFEREE 2: This person could be either an employer or, if you have no recent employment history, an adult who has known you for 3 years or longer.

For REFEREE 2: This person must be an adult who has employed you or has known you for 3 years or longer (e.g. teacher, community group leader or member, neighbour).

To add another referee, please click Add another response at the bottom of this box.

Organisation	Role
Title	Enter preferred title
First Name	Surname
Number, Street	Suburb/Town
Postcode	State
Country	Phone No/s
Email

SECTION 6
STATEMENTS

Authority for information

I hereby authorise:

• The Anglican Church and its delegates to contact and exchange information with the church organisations, churches, parishes or congregations in the section Record of Ministry and Community Roles.

• The Anglican Church and its delegates to confirm any identity documents or licenses/authorities and to conduct an Anglican National Register Check.

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

• My referees to provide to the Anglican Church and its delegates any information relevant to my application for appointment as a voluntary church worker.

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 intentional error or omission in the information in this application may prevent me from undertaking voluntary ministry in the Church.

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.

Rector/Authorised person’s approval

Name

Role

Signature

Date

SECTION 7
ADDITIONAL COMMENTS

7.1 Additional comments

Additional details for any YES answers above (provide number):

Confidential Endorsement Request Form

APPLICATION FOR ENDORSEMENT AS A VISITING SPEAKER

Confidential Endorsement Request Form

APPLICATION FOR ENDORSEMENT AS A LOCUM

SECTION 1
THE SAFE MINISTRY CHECK

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.

Our commitment to these standards requires that we conduct background referencing for all persons who intend to engage in ministry in Tasmania.

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.

Completing the Form

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

2. You can add further comments on Section 3.4 Additional Comments.

3. Have your Identity and Safe Ministry Clearance documents ready.

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.

SECTION 2
YOUR DETAILS

2.1 Personal details of person applying to be a Visiting Speaker

2.1 Personal details of person undertaking a Locum

Title:

Enter preferred title:

Legal Name/s:

Legal Surname:

Previous Name/s:

Also known as:

Date of birth: (dd/mm/yyyy)

Gender:

Street Address:

Suburb:	Postcode:
State:	Country:

Home phone:

Mobile phone:

Email:

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

2.2 Confirming your identity

Please attach to this form a clear copy of an identity document, which includes a photograph. Eg. Driver’s Licence or Passport.

Your current Australian State or Territory driver’s license.Your birth certificate; a current Australian passport; an Australian citizenship document or Australian immigration papers.

Upload Australian State or Territory Driver's License

Upload Valid Documents

2.3 Working with Vulnerable People Card Details

Working with Vulnerable People Card?

Name on Card:	Card Number:
Expiry Date: (dd/mm/yyyy)	Upload WwVP Card

WwVP or equivalent card mandatory for all persons undertaking locums.

SECTION 3
SUITABILITY FOR MINISTRY IN TASMANIA

3.1 Current Diocese & Region or denomination, &/or place of ministry*

Church / Denomination / Organisation:

Location & Diocese:

Current Role:

Commencement date: (dd/mm/yyyy)

Name of Current Bishop or Authority:

Authority Position:

Bishop / Authority Email:

3.2 Other Diocese & Region or denomination, &/or place of ministry*

If "Yes" Please complete the following

	Yes	No
Have you been a resident or ministered in any other Australian State or Territory, or in another country?

To add another record/role, please click Add another response at the bottom of this box.

Church / Denomination / Organisation

Role

Location & State

From (dd/mm/yyyy)

To (dd/mm/yyyy)

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.

3.3 Confirming your Safe Ministry Clearance

Please attach to this form clear copies of two relevant documents:

Current Australian or International Police Check#	Safe Ministry Certificate
Letter of Good Standing*	Professional Standards Clearance from your current ministry authority
Working with Vulnerable People/Children Check (your state/territory equivalent)

# Required for persons resident overseas. Current means issued within the last 3 months.
*Required for persons undertaking Locums.

Upload Safe Ministry Certificate	Upload Police Check
Upload Letter of Good Standing	Upload Professional Standards Clearance
Upload Working with Vulnerable People card

3.4 Additional Comments

SECTION 4
ENGAGEMENT DETAILS

4.1 Ministry in Tasmania details

Visiting Speaker Event details

Event type/name:

Event Coordinator:

What will the visiting speaker be doing?

Estimated dates: (dd/mm/yyyy)

Audience demographics:

Location / Church:

Locum details

Estimated dates: (dd/mm/yyyy)

Location / Church:

SECTION 5
STATEMENTS

Authority for information

I hereby authorise:

• The Anglican Church and its delegates to contact and exchange information with the church organisations, churches, parishes or congregations in the section Record of Ministry and Community Roles.

• The Anglican Church and its delegates to confirm any identity documents or licenses/authorities and to conduct an Anglican National Register Check.

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

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 intentional error or omission in the information in this application may prevent me from undertaking ministry in 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.

Date

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Confidential Safe Ministry Check Questionnaire

APPLICATION FOR APPOINTMENT AS A VOLUNTARY CHURCH WORKER AGED 16 TO 17 YEARS

Confidential Safe Ministry Check Questionnaire

APPLICATION FOR APPOINTMENT AS A VOLUNTARY CHURCH WORKER AGED 18 YEARS AND OVER

SECTION 1 THE SAFE MINISTRY CHECK

To you, the Applicant

About this Form

SECTION 1 THE SAFE MINISTRY CHECK

To you, the Applicant

About this Form

Privacy Statement

SECTION 2YOUR DETAILS

2.1 Personal details of person applying to be a Volunteer Church Worker

2.2 Confirming your identity

2.3 Working with Vulnerable People Card Details

SECTION 3SCREENING QUESTIONS

3.2 Criminal and other offences

3.3 Licenses/authorities

3.4 Respectful conduct

Respect for all

Respect for children

3.5 Financial and resource integrity

3.6 Additional comments

SECTION 4RECORD OF MINISTRY AND COMMUNITY ROLES

SECTION 5CHARACTER REFERENCE

SECTION 6STATEMENTS

Declaration by the applicant

Rector/Authorised person’s approval

SECTION 7ADDITIONAL COMMENTS

7.1 Additional comments

Confidential Endorsement Request Form

APPLICATION FOR ENDORSEMENT AS A VISITING SPEAKER

Confidential Endorsement Request Form

APPLICATION FOR ENDORSEMENT AS A LOCUM

SECTION 1THE SAFE MINISTRY CHECK

To you, the Applicant

Completing the Form

Privacy Statement

SECTION 2YOUR DETAILS

2.1 Personal details of person applying to be a Visiting Speaker

2.1 Personal details of person undertaking a Locum

2.2 Confirming your identity

2.3 Working with Vulnerable People Card Details

SECTION 3SUITABILITY FOR MINISTRY IN TASMANIA

3.1 Current Diocese & Region or denomination, &/or place of ministry*

3.2 Other Diocese & Region or denomination, &/or place of ministry*

3.3 Confirming your Safe Ministry Clearance

3.4 Additional Comments

SECTION 4ENGAGEMENT DETAILS

4.1 Ministry in Tasmania details

SECTION 5STATEMENTS

Declaration by the applicant

SECTION 1
THE SAFE MINISTRY CHECK

SECTION 1
THE SAFE MINISTRY CHECK

SECTION 2
YOUR DETAILS

SECTION 3
SCREENING QUESTIONS

SECTION 4
RECORD OF MINISTRY AND COMMUNITY ROLES

SECTION 5
CHARACTER REFERENCE

SECTION 6
STATEMENTS

SECTION 7
ADDITIONAL COMMENTS

SECTION 1
THE SAFE MINISTRY CHECK

SECTION 2
YOUR DETAILS

SECTION 3
SUITABILITY FOR MINISTRY IN TASMANIA

SECTION 4
ENGAGEMENT DETAILS

SECTION 5
STATEMENTS