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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

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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.
 Signiture of The Rt Revd Dr Richard Condie Bishop of Tasmania
The Rt Revd Dr Richard Condie
Bishop of Tasmania
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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

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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.

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.

 Signiture of The Rt Revd Dr Richard Condie Bishop of Tasmania
The Rt Revd Dr Richard Condie
Bishop of Tasmania
image

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

  2. Answer honestly by checking the appropriate box.

  3. 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.

  4. 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

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


















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


2.3 Working with Vulnerable People Card Details







SECTION 3
SCREENING QUESTIONS

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3.1 Health and social aspects
Yes No

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

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
Yes No

3.4 Respectful conduct
Yes No
Respect for all
Yes No
Yes No

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

Yes No
Respect for children
Yes No

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

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
  • Sexual contact with a person under the age of consent; or
  • Production, sale, distribution, or illegal use of child exploitation material.


3.5 Financial and resource integrity
Yes No

3.6 Additional comments




SECTION 4
RECORD OF MINISTRY AND COMMUNITY ROLES

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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





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

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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).
















SECTION 6
STATEMENTS

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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

Thankyou note




SECTION 7
ADDITIONAL COMMENTS

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7.1 Additional comments




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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

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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

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2.1 Personal details of person applying to be a Visiting Speaker
2.1 Personal details of person undertaking a Locum
















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



2.3 Working with Vulnerable People Card Details




WwVP or equivalent card mandatory for all persons undertaking locums.




SECTION 3
SUITABILITY FOR MINISTRY IN TASMANIA

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







3.2 Other Diocese & Region or denomination, &/or place of ministry* 
If  "Yes" Please complete the following
Yes No





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

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




3.4 Additional Comments




SECTION 4
ENGAGEMENT DETAILS

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4.1 Ministry in Tasmania details
Visiting Speaker Event details






Locum details





SECTION 5
STATEMENTS

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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.

Thankyou note

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