Converge Chaplaincy Application

Your Personal Information

Title(Required)

Your Name(Required)

First Middle Last

Date of Birth(Required)

Last 4 Digits of Social Security Number(Required)

Your Email Address(Required)

Enter Email Confirm Email

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Phone(Required)

Gender(Required)

Male

Female

Marital Status(Required)

Spouse Name (if applicable)

First

Children's Names (if applicable)

Church and Pastor Information and Ministry Affirmation

Applicants for chaplaincy endorsement must be actively involved in a Converge church. We further require that the church provide a statement confirming membership and affirming your calling to chaplaincy ministry. The Converge Chaplaincy Office will contact the church with information about this documentation.

Church Information

Church Name(Required)

City(Required)

State(Required)

Region(Required)

Pastor's Information

We will be requesting a letter of reference from your pastor. If you attend a larger church and feel that another pastor on staff may be a better fit than your senior pastor, you are welcome to utilize them for your reference.

Title(Required)

Name(Required)

First Last

Phone(Required)

Email(Required)

Background Check

Please upload your completed background check here.

File

Max. file size: 50 MB.

Prior or Current Military Service

Have you ever served in the military services as an officer?(Required)

Yes

No

Please indicate the number of MONTHS of active duty military service you have performed as an OFFICER. This includes time on active duty as a reservist.

Have you ever served in the military services as an enlisted person?(Required)

Yes

No

Please indicate the number of MONTHS of active duty military service you have performed as an ENLISTED person. This includes time on active duty as a reservist.

Calling

Why do you believe God has called you to become a chaplain?

Interest in and calling to chaplaincy ministry (400 words or less)(Required)

Statements for the Record

If yes is chosen to either question, provide a full explanation of the issues and results in a separate letter addressed to the Converge Chaplaincy Office. Information shared will be considered sensitive and restricted to the chaplaincy office and to those with a need to know in order to make decisions regarding ecclesiastical endorsement on behalf of the Converge.

Have you ever been charge with, accused of, moved because of, or transferred to another position because of any child abuse, sexual misconduct or sexual harassment?(Required)

Yes

No

Have you ever been arrested or convicted of any other criminal offense (not sexual in nature)?(Required)

Yes

No

Upload Letter of Explanation Here

Max. file size: 50 MB.

Affirmation of Faith

I have read and affirm agreement with the Baptist General Conference (Converge) adopted by the Baptist General Conference in 1951, reaffirmed in 1990 and amended in 1997. https://websitefiles.converge.org/docs/librariesprovider12/document-policies/converge-statement-of-faith.pdf?sfvrsn=ae44f145_0

Signature/Date(Required)

Statement of Affirmation, Agreement, Authorization and Certification

The Converge Chaplaincy Team will not process this application without agreement to the four statements below. 1. I give consent to Converge to contact any and all references provided in an effort to verify my calling, educational background and ministry and work experience. 2. I understand Converge Chaplaincy Team will conduct a background check with regard to this application. 3. I understand that Converge requires an application fee to process this application. 4. I recognize the authority of Converge Chaplaincy to grant, deny or withdraw ecclesiastical approval. Signature required for endorsement.

Signature/Date(Required)

Certification

I certify that the information and statement of this application are true and accurate and that falsification of any portion may result in the withdrawal and revocation of my ecclesiastical approval.

Signature/Date(Required)

Converge Chaplaincy Application

Converge Chaplaincy Endorsement Application

Your Personal Information

General Chaplain Information

Church and Pastor Information and Ministry Affirmation

Church Information

Pastor's Information

Educational Background

License/Ordination

Background Check

Prior or Current Military Service

References

Calling

Statements for the Record

Affirmation of Faith

Statement of Affirmation, Agreement, Authorization and Certification

Certification