Please enable JavaScript in your browser to complete this form.Endorsement is an exclusive covenant relationship between the Alliance of Baptists and the clergy persons the Alliance endorses. The Alliance provides guidance, support and discernment to those seeking to enter pastoral/spiritual care ministry and provides support to those who serve in these ministries. Endorsement is an official declaration by the Alliance of Baptists that a person meets the Alliance’s standards to serve in a specialized ministry setting of chaplaincy, pastoral counseling, or clinical education. Endorsement is to a particular ministry setting and level of certification. The endorsed clergy will represent the Alliance adhering to our ethical standards and living out our mission and covenant statements. The endorsed clergy persons agree to ongoing participation in the life of the Alliance, as well as maintaining communication and accountability to the Alliance. Application Process: The Alliance Endorser receives applications quarterly on January, April, July and October 1st. All completed materials are submitted electronically to the Endorser at endorsement@allianceofbaptists.org. The application includes a $125.00 background check fee. This can be paid online on our Give page under the Chaplain Endorsement payments section. The Endorser assigns an Endorsement Council committee member to interview the candidate. All members of the council read and comment on the candidate’s materials prior to the interview. Within six weeks of submitting their application, an Endorsement Council member will contact the candidate for a zoom interview. The interview is conducted by the appointed Endorsement Council member and the Endorser. The Endorsement Council will review the candidate’s application materials and the results of their interview. The Council will make a recommendation to the Board Committee on Endorsement. The Board will affirm or deny the endorsement. It is the intent of the Alliance to notify the candidate of the Board’s decision according to the schedule below. If the decision will be delayed beyond these dates, the candidate will be informed of the delay. Once approved for endorsement the candidate will receive a celebratory phone call or email. In addition the candidate will receive a letter and a certificate of endorsement. For military chaplains the Endorser will complete the NCMAF form. Endorsement addresses the following core standards through a process of written papers, interviews, and mutual discernment: Academic and clinical education Ministerial and theological integrity Ministry practice congruent with the Alliance Covenant and Mission Embody practices and disciplines that promote equity, justice, collegiality, and diversity in pluralistic environments Ongoing spiritual formation and growth This form is one part of applying for endorsement with the Alliance of Baptists. kindly read the Endorsement Manual carefully and submit this form and all other application materials. * = required field Part I: Personal InformationName *FirstLastPronouns *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Citizenship *United StatesOtherIf other, please explain: *Date of Birth *Liability Insurance *Who provides your liability insurance? *MeMy employerLocal Congregation *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Website/URL *Roles and Involvement (other than employment) *Activities and Interests (Involvement in Community; Ecumenical, Spiritual, and other Ecclesial Activities; Interests and Hobbies) *Part II: Professional InformationEmployer #1 Name *Job Title *Immediate Supervisor Name & Title *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWork Phone *Work Email *Website/URL *Employment Type *Full-TimePart-TimePRNVolunteerDo you have another employer to add?YesNoEmployer #2 Name *Job Title *Immediate Supervisor Name & Title *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWork Phone *Work Email *Website/URL *Employment Type *Full-TimePart-TimePRNVolunteerOrdaining Congregation *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Website/URL *Ordination Date *For those currently seeking ordination with an Alliance-affiliated congregation, kindly provide a letter from the congregation detailing where the candidate is in the process. This letter can be emailed to Malu Fairley-Collins at malu@allianceofbaptists.org. Pastoral/Spiritual Leader Experience (Applicants must demonstrate two years of pastoral/spiritual leadership experience in a congregation or specialized ministry setting.) Employer *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Job Title *Dates of Service *Do you have another employer to add?YesNoEmployer *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Job Title *Dates of Service *Do you have another employer to add?YesNoEmployer *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Job Title *Dates of Service *Do you have another employer to add?YesNoEmployer *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Job Title *Dates of Service *Do you have another employer to add?YesNoEmployer *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Job Title *Dates of Service *Do you have another employer to add?YesNoEmployer *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Job Title *Dates of Service *Higher Education Degree/Certification *Year Completed *Institution *City, State *Would you like to add another degree/certificate?YesNoDegree/Certification *Year Completed *Institution *City, State *Clinical Pastoral Education Center & LocationDates# of UnitsCity, StateDo you have additional Clinical Pastoral Education to add? YesNoCenter & Location *Dates *# of Units *City, State *Do you have additional Clinical Pastoral Education to add?YesNoCenter & Location *Dates *# of Units *City, State *Are you transferring your endorsement? *YesNoCurrent Endorsing Body *Contact Person *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Statement of reason to change/transfer endorsement to the Alliance of Baptists: *Part III: Ethical PracticeOutside of your place of employment, what professional organizations’ code of ethics do you subscribe to? *Are you in compliance with your code of ethics? *YesNoHave allegations of misconduct including but not limited to sexual harassment, exploitation or misconduct, physical abuse, child abuse, or financial misconduct led to civil, criminal, ethical, professional, or ecclesiastical complaint(s) being filed against you? *YesNoPlease include an explanation for each incident or action that caused you to answer “yes.” Please include the date, nature, and place of each incident; where and when each was adjudicated; or the disposition. Indicate steps taken toward resolution, if any. *Have allegations of misconduct including but not limited to sexual harassment, exploitation or misconduct, physical abuse, child abuse, or financial misconduct led to your resignation, termination or transfer from a position? *YesNoPlease include an explanation for each incident or action that caused you to answer “yes.” Please include the date, nature, and place of each incident; where and when each was adjudicated; or the disposition. Indicate steps taken toward resolution, if any. *Have allegations of misconduct including but not limited to sexual harassment, exploitation or misconduct, physical abuse, child abuse, or financial misconduct led you to resign, terminate or transfer from a position to avoid such charges? *YesNoPlease include an explanation for each incident or action that caused you to answer “yes.” Please include the date, nature, and place of each incident; where and when each was adjudicated; or the disposition. Indicate steps taken toward resolution, if any. *Have allegations of misconduct including but not limited to sexual harassment, exploitation or misconduct, physical abuse, child abuse, or financial misconduct led to your conviction of a misdemeanor or a felony? *YesNoPlease include an explanation for each incident or action that caused you to answer “yes.” Please include the date, nature, and place of each incident; where and when each was adjudicated; or the disposition. Indicate steps taken toward resolution, if any. *Has your driver’s license been suspended or revoked within the last five years due to reckless driving or driving while intoxicated and/or under the influence of a controlled substance? *YesNoIn your judgment, are there any facts or circumstances involving you or your background that would warrant further review before you are entrusted with the responsibilities of ministry on behalf of a calling body of the Alliance of Baptists? *YesNoPlease include an explanation for each incident or action that caused you to answer “yes.” Please include the date, nature, and place of each incident; where and when each was adjudicated; or the disposition. Indicate steps taken toward resolution, if any. *I recognize my responsibility to update this misconduct disclosure in a timely manner should there be a change of status in any of the issues named above. Signature * Clear Signature Date / Time *DateTimePart IV: Authorization for Release Of Personal Information, Confirmation of Accuracy of Statements, Indemnification of Alliance, and Release of Claims Against the AllianceI am submitting this application to the Alliance as part of the Endorsement Process of the Alliance. I agree to cooperate with the Alliance, and to abide by all decisions of the Alliance. I understand and agree that the Alliance has the sole authority to grant or deny Endorsement, in its sole discretion, and that the decision of the Alliance to grant or deny endorsement is final and not subject to appeal or review. Further, if the Alliance should determine that my endorsement should be withdrawn, I agree to abide by that decision, which I agree shall be final and shall not be subject to review. I understand that there is no contractual right to endorsement by the Alliance, that the Alliance may decide to withdraw my endorsement in its discretion at any time, and that I will have no legal claim of any kind against the Alliance as a result of any decision to grant, deny or withdraw endorsement. I confirm that the information provided on this application, and any information I may provide at any time during the application process, is accurate and complete. I understand that the Alliance will rely on the statements I am making in this application and during the application process. I agree that all of the information provided in this application and in the application process may be verified by the Alliance or anyone acting on behalf of the Alliance. I authorize the Alliance, or anyone acting on their behalf, to make any and all contacts necessary to verify my history of prior employment, and to inquire regarding any prior arrest, criminal records, professional, religious, or judicial proceedings involving me as a defendant. I authorize the Alliance, or anyone acting on their behalf, to make whatever contacts the Alliance considers necessary in order to obtain any other information the Alliance considers necessary in order to decide on my Application, including but not limited to contacting individuals, churches and organizations listed on this Application as references. I hereby authorize previous employers, any pastoral care organizations, and any religious judicatory and/or any law enforcement or judicial authority to release any and all requested information about me. I hereby authorize any individuals, churches, or other organizations listed on this Application to provide any and all requested information directly to the Alliance or anyone acting on their behalf. I agree to sign any additional authorizations that may be necessary for the Alliance to obtain this information. I will pay for any additional costs for the mandatory background check. I have thoroughly read this document, and I understand its terms. I understand fully that the information obtained from other parties may be used to deny my endorsement from the Alliance of Baptists. I understand that the Alliance has no independent obligation to verify the accuracy of any information received from those other parties. I understand and agree that being endorsed by the Alliance of Baptists does not create any employment relationship with the Alliance, or establish any other kind of supervisory relationship with the Alliance. I agree that if I am endorsed by the Alliance of Baptists, I will not tell anyone that I have any kind of employment or supervisory relationship with the Alliance. I understand and agree that the Alliance is relying upon the accuracy and completeness of my statements in this Application, and during the Application process, in making any decisions about Endorsement. I agree to indemnify and hold harmless the Alliance against any claims against the Alliance based upon or arising from (i) any actions I may take during the time that I am Endorsed by the Alliance, or (ii) any information that I have supplied to the Alliance as part of this process. I agree to indemnify and hold harmless the Alliance against any claims based upon or arising from any statements that I may make that misrepresent the nature of my relationship with the Alliance. Finally, I hereby release any and all claims that I may have against the Alliance as a result of my Application for Endorsement, including without limitation claims based upon or arising from (i) actions that the Alliance may take in contacting any third-party as part of that process, or (ii) any actions that the Alliance may take during the time that the Alliance has granted me Endorsement, or (iii) any decision by the Alliance to deny Endorsement or to withdraw Endorsement once granted. Signature * Clear Signature Date / Time *DateTimePart V: Covenantal Code of Ethics for Endorsed ClergyAs an endorsed clergyperson of the Alliance of Baptists, I make the following commitments: I will work cooperatively and collegially with those with whom I serve in the ministry to which I have been called. I will stand in a supportive relationship with my colleagues in ministry, offering and receiving counsel and support in times of need. I will maintain the highest ethical standards with colleagues, institutions, or congregations that employ me. I will recognize the power my ministry gives me and refrain from practices that are harmful to others and which endanger my integrity or my professional effectiveness. I will use my ministerial status, position and authority in ways that do not abuse, misguide, negatively influence, manipulate or take advantage of anyone, especially children. I will personally and professionally support persons who experience discrimination on the basis of gender, sexual identity, gender expression, race, ethnicity, age, marital status, national origin, religion, physical ability, or mental ability. I will seek to know, understand and respect the diversity of opinions, beliefs, and practices of others. I will be a good steward of that which God provides and handle my own finances and those of my partners in ministry and my place of employment honestly and with great care. I will seek to grow in faith, knowledge, and the practice of ministry through spiritual practices, study, professional development, and service. I will live a life that honors my commitments to myself and my loved ones, including the need for privacy, time apart, and time together. I will honor all confidences shared with me in my capacity as a clergyperson, unless not allowed by law, and I will maintain such confidentiality even when the pastoral relationship has ended. I will navigate transitions between ministries carefully to support the ministry of those who follow me as well as the well-being of those with whom I have had a pastoral relationship. With God’s help and the help of my colleagues in ministry, I make this covenant. Signature * Clear Signature Date / Time *DateTimePart VI: Alliance of Baptists Complaint PolicyAll complaints and reports of misconduct relating to Alliance of Baptists Endorsed Clergy will be handled as follows: Any member of the Alliance of Baptists Board, Alliance of Baptists staff, or the Endorsing Council who receives such information, shall promptly inform the President of the Alliance of Baptists of that information. Once the President has been informed, no further action shall be taken, except by the President, acting in consultation with legal counsel, or by legal counsel, as authorized by the Alliance of Baptists Board of Directors. After receiving such information, the President of the Alliance of Baptists shall promptly confer with legal counsel for the Alliance of Baptists, and take whatever action the President and legal counsel conclude is appropriate under the circumstances. The President of the Alliance of Baptists and legal counsel will consider how and when to consult with the Executive Committee and/or the full Board of Directors of the Alliance of Baptists, depending on the nature of the issues raised and the urgency of the matter. The President of the Alliance and legal counsel will consider whether consultation with the the Endorsing Council is appropriate under the circumstances. The Alliance of Baptists’ response may include notification of Alliance of Baptists-affiliated congregations or of certifying organizations and employers, as is appropriate under the circumstances. This policy shall not apply to reports of misconduct by Alliance of Baptists Employees, Officers or Directors, which shall be governed by the existing Whistleblower Resolution and procedures. This policy shall be distributed annually to all Alliance of Baptists staff, all members of the Board of Directors of the Alliance of Baptists, all members of the Endorsing Council. Each person receiving the Policy shall sign and return a copy indicating that they understand the policy, have complied with it, and will comply with it. As part of the annual renewal process, Endorsed Clergy shall indicate that they understand this policy, have complied with it, and will comply with it. Adopted by the Board of Directors, Alliance of Baptists, May 1, 2014 Signature * Clear Signature Date / Time *DateTimeSubmitSave and Resume Later Your form entry has been saved and a unique link has been created which you can access to resume this form. Enter your email address to receive the link via email. Alternatively, you can copy and save the link below. Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted. Copy Link Email * Send Link
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