Application for appointment in the position of Community Chaplain

Community Chaplain

Instructions: Please complete the application fully. Read and check the affirmation at the end of the form.

Name

Last *

First *

Middle *

Other names used (Include maiden names)

Phone # *

Email *

Address

Street *

City *

State *

Zip Code *

Personal Information

Date of Birth *

Month

Day

Year

Present Age *

Gender *

Male

Female

Transgender

Race

Are you a Citizen of the U.S? *

Yes

Do you possess a valid Driver’s license? *

Yes

What Church/ Faith Organization do you belong to? *

Do you hold a leadership role with the above organization? If So, Please describe *

How many years have you been involved with that organization? *

A pastoral (Leader) letter of recommendation is required for this application, are you able to provide a letter within the next 2 weeks? *

Yes

How did you find out about the Community Chaplaincy? *

Are you willing and able to commit to 20 volunteer hours per month? *

Yes

Education *

High School Diploma

GED

High School Information

Name/Address *

Yrs. attended *

College/Trade information

Name/Address *

Yrs. attended *

Course *

Degree *

Employment History

Currently *

Retired

Employed

Unemployed

Employer 1

Address *

Duties *

Hire Date *

Month

Day

Year

Reason for Leaving *

Employer 2

Address

Duties

Hire Date

Month

Day

Year

Reason for Leaving

Employer 3

Address

Duties

Hire Date

Month

Day

Year

Reason for Leaving

Employer 4

Address

Duties

Hire Date

Month

Day

Year

Reason for Leaving

Military

Have you served in the military? *

Yes

Branch of Service

EOD

Active

Reserves

Retired

Discharged Date

Month

Day

Year

Type of Discharged

Discharged

Yes

Additional questions

Have you ever previously applied for any position in the Baltimore Police Department or any other Law Enforcement Agency? *

Yes

What Agency?

What Position?

When?

Have you ever been a defendant in any court action *

Yes

Please explain

Are you now, or have you ever been a member of any organization, corporation, company, partnership, association, trust, foundation, fund, club, society, committee, political party, or any group of person whether or not incorporated, which engages in or advocates, abets, advises or teaches, or a purpose of which is to engage in, or advocate, abet, advise or teach activities intended to overthrow, destroy or alter or assist in the overthrow, destruction or alteration of the Constitutional form of Government of the United States or of the State of Maryland, or of any political sub division of either of them by revolution, force, violence or other unlawful means? *

Yes

Please explain

I hereby affirm that there are no intentional misrepresentation or falsifications in the foregoing statement and answers to questions. I am aware that should investigation disclose any such misrepresentation or falsifications, my application shall be rejected or if already employed my employment must be terminated. By entering your name into the signature field of this online application, you are legally signing the document. *

Agree

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