Online Application 1 2 3 4 5 6 7 Which endorsement credential(s) are you are applying for? Please check all that apply. ArmyNavyAir ForceMilitary Active DutyMilitary GuardMilitary ReserveMilitary SeminarianCivil Air PatrolVeterans AffairsCivilian HealthcareCorrectionalWorkplacePublic SchoolProfessional Pastoral CounselorCertified VolunteerOther Previous Next 1. Last Name First Name Middle Name 2. Date of Birth SSN 3. Home Address City State Zip Code Home Telephone Email Address 4. Office Address City State Zip Code Office Telephone Email Address 5. Are you an American Citizen? YesNo By birthBy Naturalization Naturalization date: *Items 6 - 9 For Military Applicants Only - all others will skip to #10 Are you a military applicant? YesNo 6. Height 7. Weight lbs 8. Have you any physical defects? YesNo Briefly describe: 9. Do you have any disabilities? YesNo Briefly describe: 10. Have you ever been hospitalized for mental health concerns? YesNo Briefly describe: 11. Have you ever been charged with or convicted of a criminal offense? YesNo When? Where? What were the charges? 12. Have you ever committed a serious criminal act for which you were not charged? YesNo When? What was it? 13. Have you ever filed bankruptcy or had any serious financial problems? YesNo What date? 14. What are your hobbies? 15. Describe your athletic ability: Previous Next 1. Marital Status: MarriedSingleEngagedSeparatedDivorced Date of marriage: Spouse's name: Are you and your spouse living together? YesNo To what extent does your spouse share/support your interest in pastoral caregiving? 2. Do you have a former living companion? YesNo Please explain your history. [Note: A divorce is not an automatic disqualifier] 3. Do you have children? YesNo list name and date of birth of each 4. List permanent emergency contact: (Someone other than yourself or your spouse, who will always know your whereabouts) Previous Next 1. Date of Salvation 2. Date filled with the Holy Spirit 3. When were you licensed? By whom? 4. When were you ordained? By whom? 5. Local church affiliation 6. Have you previously applied for approval or endorsement? YesNO With whom? What disposition was made of this previous application? 7. Ministerial experience, beginning with the present and working back: Church or Employer Position Held Address From date: To date: Remove+ Add Another Ministerial Experience Previous Next 1. College and Seminary training, beginning with the most recent and working back: Name of College/Seminary From date: To date: Address of College/Seminary Major Total Hours Degrees Conferred Transcript (.pdf) RemoveAdd Another School 2. Have you had any clinical pastoral education/training? YesNo How many units? Where did you receive this clinical pastoral training? 3. Other training, certifications, and memberships you have to prepare for chaplaincy: Previous Next 1. Occupational experience (list most recent employers): Employer Position Held Address From date: To date: Remove+ Add Another Occupational Experience Previous Next Do you have prior military service? YesNo Please click the "Next" button below to continue your application. 1. Previous Military Service: Branch of Service —Please choose an option—Air ForceAir Force ReserveAir National GuardArmyArmy National GuardArmy ReserveCoast GuardCoast Guard ReserveMarine CorpsMarine Corps ReserveNavyNavy ReserveSpace Force Service Dates to Grade —Please choose an option—EWO - —Please choose an option—12345678910 RemoveAdd Another Prior Service 2. If discharged, type of discharge you received: Note: If discharged, you must upload a copy of your discharge [DD Form 214] to the CSC:
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