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#20-005188-0001
Supplemental Questionnaire

Last Name
First Name

 

***Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit.***


1.

Are you willing to work with multiple religious faiths other than your own?

Yes No
2.

Do you posses a current Ecclesiastical/Religious endorsement from a religious affiliated body that certifies your experience and abilities in support of the following:

*Validates your membership and/or ordination with a recognized religious organization of one’s own faith
*Attests to one’s suitability, credentials and professionalism for supporting correctional religious services’ job functions;
*Affirms that you have no present moral barrier to conduct religious activities;
*Attests that you possess the necessary leadership abilities to conduct worship functions, sacraments, ordinances, ceremonies, rites and observances required.

If yes, please ensure you complete the certification area on the employment application and attach a copy of your certification.

If you cannot provide a copy now, you do understand that this is a required document to produce before hiring.

Yes No
3.

Do you have one year of experience specifically counseling others or completion of one unit in Clinical Pastoral Education as accredited by the Association of Clinical Pastoral Education, or its equivalent, YES or NO.  If YES, please describe your experience in detail, including where and when you received this experience or where and when you completed your one or more units of Clinical Pastoral Education.  If NO for both, please write N/A.

4.

Do you have a degree in theology, religious studies, or sacred studies from an accredited institution, seminary, or equivalent, YES or NO.  If YES, please list your degree and where and when you obtained it.  If NO, please write N/A.


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