Form - Application for Admission to the Permanent Diaconate

Application for Admission to the Permanent Diaconate

I. Personal Information

Date of Application

MM slash DD slash YYYY

Legal Name*

First Middle Last Preferred

If married, Name of Spouse

First Middle/maiden Last Preferred

Home Address

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

Home Phone

Cell Phone

Work Phone

Email Address

Date of Birth

MM slash DD slash YYYY

Age

Please enter a number from 32 to 63.

Place of Birth

City

State

Country

Are you a US Citizen?

Yes

Citizenship Country

Type Visa, expiration date, comments

Primary Language

Other Languages and Fluency

II. Employment History

Job Status

If "Other", describe

Current Employer Name

Current Employer Mailing Address

Street Address City State / Province / Region ZIP / Postal Code

Current Occupation / Job Title

Date Started

MM slash DD slash YYYY

Days per Month Spent Traveling

Employment / Job History (List employers you have had over the last 20 years, most recent first)

Employer Name & Location

Job Title / Occupation

No. Years in Job

Year Departed

Reason for leaving

Are you a veteran of the US military

Yes

Describe rank attained, branch of military, length of service, type discharge

III. Sacramental Information

Note: you are also required to submit a baptismal certificate with notations dated within six months of the application filing date.

Baptism Date

MM slash DD slash YYYY

Baptism Parish and Location (Church, City, State, Country)

1st Communion Date

MM slash DD slash YYYY

1st Communion Parish and Location

Catholic Confirmation Date

MM slash DD slash YYYY

Catholic Confirmation Parish and Location

Current Marriage Date

MM slash DD slash YYYY

Current Marriage Parish and Location

Did you become Catholic as Adult (RCIA)

Yes

How many years have you been Catholic

Additional Marriage Information (please list all prior marriages)

Spouse's Name

Date of Marriage

Date of Annulment

Diocese

IV. Parish Information

Current Parish Name

Address

Pastor

Number of Years

Other Parishes of which you have been a member over the last five years, most recent first

Other Parish Name

Address

Pastor

Number of Years

V. Family History

Please list parents, step-parents and guardians you had while growing up

Name

Relationship

Religion

Living

If you currently provide care, describe

Please list children and dependents

Name

Relationship

Age

At Home

List any special needs or serious illnesses

Please list any other persons currently living in your household

Name

Relationship

Age

Describe why person is in your home

VI. Academic Information

List your educational and academic training, starting with the last high school you attended

Type of Institution

Name of Institution

Year Completed

Field of Study / Major

Type Degree received

Have you completed the two year Lay Ministry program offered by the Diocese of Charlotte?

Yes

Year Completed

Describe any additional training you have received that may be relevant to your application to the Permament Diaconate

Have you ever attended a seminary

Yes

Which seminary, When did you attend, and Why did you leave?

VII. Parish and Community Volunteer Service

Please list your most significant volunteer activities within the parish (extraordinary minister of communion, lector, catechist, music ministry, parish council, finance council, K of C, tribunal advocate, RCIA team, youth ministry...)

Parish Activity or Ministry

Years in Ministry

Still Active?

If not active, year stopped

When active, hrs per month

If applicable, list certification received or positions held

Please list your most significant volunteer activities outside of the parish and in the community (soup kitchen, prison ministry, hospital ministry, guardian ad litem, homeless shelters, civic organizations, food pantries...)

Community Volunteer Activities

Years as volunteer

Still Active?

If not active, Year stopped

When active, hrs per Month

If applicable, list certification received or positions held

Describe any additional talents and experiences that may be relevant to your application to the Permanent Diaconate

VIII. Health Information

In addition to the health questions below, you will also be required to have your physician complete a separate medial report.

Please rate your general health

List any existing physical or mental limitations which you currently have

Have you ever received disability payments?

Yes

Have you been hospitalized in the last 5 years?

Yes

Have you ever experienced problems or been treated for chemical dependency, emotional / psychological difficulties, alcohol abuse, hypertension?

Yes

Please explain any of the above health questions in which you answered "Yes"

IX. Miscellaneous Items

Have you ever applied to this or any other Permanent Diaconate program? If yes, please indicate the Diocese and approximate date of application below.

Yes

Have you ever been charged with, indicted or convicted of a crime other than a minor traffic violation? if yes, please give date, place, and nature of the crime in space below. (Note: During formation, all candidates will be asked to sign a release and have a criminal background check performed.)

Yes

Have you ever declared bankruptcy? If yes, please describe date and brief explanation below.

Yes

Are there any pending legal claims or charges against you, your family business. If so, please explain details below.

Yes

Have you ever been involved in, reprimanded for or disciplined by an employer or educational institution for misconduct including acts of dishonesty, fraud or deceit, misrepresentation of credentials, academic misconduct such as cheating or plagiarism. If so, please explain details below.

Yes

Have you ever been accused of sexual misconduct or harassment. If so, please explain details below.

Yes

Please explain any of the above question in which you answered "Yes"

Place rate your overall financial health

Describe any financial problems you have had in the last five years

X. Personal Statements

Who has encouraged you the most in your pursuit of the Diaconate?

Please list the name of a Deacon who might know you well enough to provide a reference. If none, leave blank.

Please provide short answers to the questions below

1. Why are you applying to the Permanent Diaconate?

2. Describe two personal attributes which you feel make you most qualified to be a Permanent Deacon.

3. Describe two personal attributes which you feel make you least qualified to be a Permanent Deacon.

4. If you are ordained as a Permanent Deacon, describe how you think your life will change?

5. What church practices, traditions, and teachings do you find the most challenging to accept or would like to see improved?

6. Describe your faith experiences (or lack of faith experiences) that have led you to apply to the Permanent Diaconate. Start from a young age and continue the narrative to where you are currently.

Additional Comments? On your answers to any questions on this application, do you wish to make any additional comment or clarification

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