Have you attended a 2-day QDCN Workshop? *

If you have not attended a 2-day QDCN Training Workshop, your application will not be considered - please check our current training offerings on this website.

Yes - please proceed with this application

No - please don't proceed with thsi application and register for a 2-day workshop on this website

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Personal Phone *

(###)

###

####

Work Phone

(###)

###

####

Residential Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Postal Address

(If blank, residential address will be used for post)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Address of your church *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you currently, or have you ever been ordained accredited as a pastor, priest or equivalent? *

Yes

No

Have you ever been convicted of a criminal offence? *

Yes

No

Do you currently hold a QLD Working With Children Blue Card? *

Please note that you will need to have your Blue Card/ New application Linked to the QDCN Auspicing Organisation: 'ChaplainWatch' and you may receive contact regarding this link in future

Yes

No

Card Expiry

MM

DD

YYYY

Pastoral/Denominational Referee *

(MUST be your local church Priest or Pastor or a denominational representative who has known you in a ministry capacity)

First Name

Last Name

Phone

(###)

###

####

Personal/Professional Referee *

(Not family, who has known you for 3 years)

First Name

Last Name

Phone

(###)

###

####

Acknowledgements: *

1. I understand that by completing this enquiry form, my referees and I may be contacted by a representative of QDCN to ascertain my suitability for the role of volunteer Disaster Chaplain with QDCN

2. I understand that completing this application does not guarantee my acceptance into the role of volunteer Disaster Chaplain with QDCN, and that QDCN reserves the right to accept or reject this application into the role of volunteer Disaster Chaplain with QDCN, according to QDCN's own reasoning and I may not be provided with an explanation of the outcome of this enquiry.

3. I understand that representatives of QDCN may request further information and that failing to provide requested information may delay the outcome of this enquiry or result in rejection of my application into the role of Disaster Chaplain with QDCN

4. All information I have provided on this enquiry form is true and correct to the fullest extent of my knowledge.

Date *

MM

DD

YYYY