Privacy Policy (as from 25 May 2018)

Who we are

We are: St. Dunstan’s Anglican Church.

We are located at: 163 Wattle Valley Road, Camberwell, Victoria. 3124

Our website address is: http://stdunstans.org.au.

What personal data we collect and why we collect it

The information collected through our website may include personal data, such as name and address, email address, and information about cookies.

The limited personal data we collect, is used to identify you and to pass on the information you provide to the person/officer you are asking to have your contact details relayed to.

Personal data is not just created by a user’s interactions with our site. Personal data is also generated from technical processes such as contact forms, comments, cookies, analytics, and third party embeds.

St. Dunstan’s Anglican church Camberwell may collect information about our parishioners. The parish database contains the following parishioner information: Name, address, and telephone numbers and email address.

By default WordPress, on which our website is built, does not collect any personal data about visitors, and only collects the data shown on the User Profile screen from registered users. However some of our plugins may collect personal data.

Comments

When visitors leave comments on the site we may collect the data shown in the comments form, and also the visitor’s IP address and browser user agent string to help spam detection.

An anonymized string created from your email address (also called a hash) may be provided to the Gravatar service to see if you are using it. The Gravatar service privacy policy is available here: https://automattic.com/privacy/.

After your comment has been forwarded to the appropriate church officer you have nominated and your comment or request has been dealt with, your profile and the context of your comment are deleted.

Media

If you upload images to the website, you should avoid uploading images with embedded location data (EXIF GPS) included. Visitors to the website can download and extract any location data from images on the website.

Contact forms

Our contact form submissions are retained for a certain period for parishioner service or guest service purposes, that is after the person/officer, who you have requested your information to be forwarded to, has received it, the details are then deleted. Note we do not use the information submitted through them for marketing purposes.

Cookies

If you leave a comment on our site you may opt-in to saving your name, email address and website in cookies. These are for your convenience so that you do not have to fill in your details again when you leave another comment. These cookies will last for one year.

If you have an account and you log in to this site, we will set a temporary cookie to determine if your browser accepts cookies. This cookie contains no personal data and is discarded when you close your browser.

When you log in, we will also set up several cookies to save your login information and your screen display choices. Login cookies last for two days, and screen options cookies last for a year. If this facility is available and you select “Remember Me”, your login will persist for two weeks. If you log out of your account, the login cookies will be removed.

If you edit or publish an article, an additional cookie will be saved in your browser. This cookie includes no personal data and simply indicates the post ID of the article you just edited. It expires after 1 day.

Embedded content from other websites

Articles on this site may include embedded content (e.g. videos, images, articles, etc.). Embedded content from other websites behaves in the exact same way as if the visitor has visited the other website.

These websites may collect data about you, use cookies, embed additional third-party tracking, and monitor your interaction with that embedded content, including tracing your interaction with the embedded content if you have an account and are logged in to that website.

Analytics

We do not use any plug-in or software that allows analytics tracking.

By default WordPress, on which our website is built, does not collect any analytics data. However, many web hosting accounts collect some anonymous analytics data.

Who we share your data with

The appropriate minimum data, such as name, address, phone numbers and or email address, which allows the Priest or an officer of this church to contact you regarding the matter that you have raised, will be passed on to them in order that they may contact you. We do not share directly any data with any partners, cloud-based services, payment processors, and third party service providers. However, if you use the payment form to make a donation to the St Dunstan’s Building Restoration Fund from this website you will be using the Westpac Banking Corporation transaction portal, in order to find out what data they receive please read their Privacy Policy use this link: https://www.westpac.com.au/privacy/privacy-policy/

How long we retain your data

If you leave a comment, the comment and its metadata are retained indefinitely. This is so we can recognize and approve any follow-up comments automatically instead of holding them in a moderation queue.

For users that register on our website (if any), we also store the personal information they provide in their user profile. All users can see, edit, or delete their personal information at any time (except they cannot change their username). Website administrators can also see and edit that information.

What rights you have over your data

If you have an account on this site, or have left comments, you can request to receive an exported file of the personal data we hold about you, including any data you have provided to us. You can also request that we erase any personal data we hold about you. This does not include any data we are obliged to keep for administrative, legal, or security purposes.

Where we send your data

Visitor comments may be checked through an automated spam detection service. Then your data, as indicated above, will be forwarded to the appropriate officer of this church.

Your contact information

If you have any privacy-specific concerns please contact the Vicar of St. Dunstan’s Anglican Church, Camberwell Victoria Australia 3124, directly by email at: vicar@stdunstans.org.au  or by clicking here and using our Contact Us Form.

Additional information

We do not use our site for commercial purposes and do not engage in more complex collection or processing of personal data.

How we protect your data

What data breach procedures we have in place

We have in place an internal reporting systems, and a contact mechanisms, if there is any perceived or real breach of privacy, or if we receive a complaint from a parishioner or guest.

What third parties we receive data from

On this website we currently do not receive data from any third parties.

What automated decision making and/or profiling we do with user data

We do not use automated decision making and/or profiling on this church website.

Industry regulatory disclosure requirements

Being a member of The Anglican Church in Australia, and subject to additional privacy laws under the Anglican Dioceses of Melbourne, we follow the following Professional Standard regulations:-

Professional Standards Uniform Regulations 2017 (Melbourne)

as at 23 November 2017
The Archbishop-in-Council of the Diocese of Melbourne makes the following Regulations

pursuant to section 185 of the Professional Standards Uniform Act 2016 (Melbourne):

Short title

1. These Regulations may be cited as the Professional Standards Uniform Regulations 2017 (Melbourne).

Commencement

2. These regulations come into operation on 1 July 2017.

Definition

3. In these Regulations —
the Act means the Professional Standards Uniform Act 2016 (Melbourne). Other expressions have the same meaning as in the Act.

Form of consent to formal process

4. The written consent of a complainant under section 22(1) of the Act must be in Form 1 of the Schedule, with any necessary modifications.

Form of application for clearance for ministry

5. An application to the Office of Professional Standards for a clearance for ministry under section 50 of the Act must be in Form 2 of the Schedule, with any necessary modifications.

Form of application for clearance for service

6. An application to the Office of Professional Standards for a clearance for service under section 60 of the Act must be in Form 3 of the Schedule, with any necessary modifications.

Form of reference to the Professional Standards Board

7. A reference by the Professional Standards Committee to the Professional Standards Board under section 69 of the Act must include a notice in Form 4 of the Schedule, with any necessary modifications.

Form of application for review of a decision of the Professional Standards Board

8. An application for review of a decision of the Professional Standards Board under section 89 of the Act must be in Form 5 of the Schedule, with any necessary modifications.

Reg. 4

SCHEDULE
Professional Standards Uniform Regulations 2017 (Melbourne)FORM 1

CONSENT OF COMPLAINANT TO FORMAL PROCESS

under s 22 of the z 2016 (Melbourne) (the Act)TO: The Director of Professional Standards

Name of complainant— Address—
Description of complaint:

I the above named complainant CONSENT to —

  1. (a)  the giving by the Director of notice of the complaint and the identity of the complainant to the respondent;
  2. (b)  the investigation of the complaint by the PSC or its delegate;
  3. (c)  the PSC otherwise dealing with it under this Act;
  4. (d)  the hearing and determination of the complaint by the Board and on any review, the Review Board, either by hearing or otherwise in accordance under this Act; and
  5. (e)  the making of recommendations to the Archbishop or other Church authority in accordance with this Act.

__________________

NOTE: Section 22 of the Act provides:

22. (1)

The Director must prior to any investigation seek from the complainant his or her written consent to—

  1. (a)  the giving by the Director of notice of the complaint and the identity of the complainant to the respondent;
  2. (b)  the investigation of the complaint by the PSC or its delegate;
  3. (c)  the PSC otherwise dealing with it under this Act;
  4. (d)  the hearing and determination of the complaint by the Board and on any review, the Review Board, either by hearing or otherwise in accordance under this Act; and
  5. (e)  the making of recommendations to the Church authority in accordance with this Act.
  1. (2)  If the complainant (other than the Director) has not given the written consent referred to in the preceding subsection—
    1. (a)  the Director and the PSC must, subject to any obligation referred to in subsection (3), respect the confidentiality of the identity of the complainant;
    2. (b)  the PSC may, subject to subsection (2)(a), investigate the complaint but shall not be required to do so and otherwise to refer it to the Board;
    3. (c)  the PSC may but is not obliged to dismiss the complaint or take no further action in relation to the complaint; but
    4. (d)  the PSC may with the consent of the complainant arrange with the complainant, the respondent and if appropriate, the Church authority mediation conciliation neutral evaluation or other alternative resolution of any dispute associated with the complaint, with a view to addressing any breakdown in relationships and achieving a reconciliation between the parties.
  2. (3)  The relevant obligations are under any State or Federal law—
    1. (a)  to disclose information to a member of the police force1; and
    2. (b)  otherwise to take reasonable steps to reduce or remove a substantial risk that a relevant child will become the victim of a sexual office committed by a person or of over the aged of 18 years who is associated with the Church in the diocese.2
  3. (4)  In this section, ‘relevant child’ means a child (whether identifiable or not) under the age of 16 years who is, or may come, under the care, supervision or authority of the Church in the Diocese.3

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1 In certain circumstances, it is an offence punishable by 3 years imprisonment for any person of or over the age of 18 years to fail to disclose to a member of the police force of Victoria information relating to the commission of a sexual offence against a child under the age of 16 years: s327 of the Crimes Act 1958 (Vic).
2 See Crimes Act 1958 (Vic), s49C. A negligent failure by person in authority to protect a child from a sexual offence is also an offence

3 The definition reflects the definition of ‘relevant child’ in s49C.

Reg. 5

Form 2

SAFE MINISTRY CHECK – APPLICANT

Professional Standards Uniform Regulations 2017 (Melbourne)

ANGLICAN CHURCH OF AUSTRALIA DIOCESE OF MELBOURNE

SAFE MINISTRY CHECK

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APPLICANT’S SCREENING QUESTIONNAIRE
For Ordination Candidates, Clergy and Authorised Lay Ministers

(Adopted by the General Synod in October 2004. Last revision in May 2017)

CONFIDENTIAL APPLICATION FOR CLEARANCE FOR MINISTRY PERSONAL DETAILS:

Title:
Surname: Christian Names: Previous Names: Address:

Home Phone No: Mobile Phone No: Date of Birth: Marital Status: Occupation:

Male/Female

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Work Phone No: Email:

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SAFE MINISTRY CHECK – APPLICANT

Applicant’s Screening Questionnaire
for Ordination Candidates, Clergy and Authorised Lay Ministers

The Anglican Church of Australia has established standards of conduct for clergy and church workers to maintain a safe and healthy ministry environment.

Our commitment to these standards requires that we conduct background referencing for all persons who intend to engage in ordained and lay ministry in Australia. This request for information is being made to comply with Anglican Church of Australia policies, and not because we have any reason to believe that any applicant has in fact engaged in inappropriate conduct. What follows is our Screening Questionnaire for those who intend to carry out ordained or paid or licensed or authorised lay ministry in Australia.

As part of this process, we request you to answer a series of questions which are, of necessity, intimate in nature. If you do not understand the question or would like to discuss your answer further, please feel free to call the Director of Professional Standards. The completed questionnaire should be sent directly to the address below and will be kept secure in our confidential files, in accordance with the Privacy Act. Except as may be required by law, or by church disciplinary procedures, the information you supply will be used only for screening and disciplinary purposes. Where required by law, the information you supply will be produced.

You must answer all questions. You should add any additional information under the question or on a separate page. Please note that a yes answer to a question will not automatically rule an applicant out of selection.

Please note. We do not interpret a yes answer to a question as a charge of professional misconduct. Each Diocese in Australia provides a formal process for making such a charge.

Thank you for your time. Yours faithfully

Registrar, Diocese of Melbourne

Please return this Questionnaire in the enclosed, stamped, pre-addressed envelope directly to:

The Director of Professional Standards Office of Professional Standards Kooyoora Ltd
PO Box 329

CANTERBURY 3124

SAFE MINISTRY CHECK

– APPLICANT

APPLICANT’S SCREENING QUESTIONNAIRE
FOR ORDINATION CANDIDATES, CLERGY AND AUTHORISED LAY MINISTERS

Please tick either “yes” or “no” for each question.

If the answer to any of the following questions is “yes”, please indicate the question number, provide relevant information regarding your response and indicate current status of the issue(s) if any.

A yes answer will not automatically rule an applicant out of selection.

Throughout this document charged* or charges* indicates allegations made in writing and known to you OR allegations made to a court, disciplinary tribunal or employer in Australia or in any other country.

Throughout this document child exploitation material* means material that describes or depicts a person who is or who appears to be a child –

  • engaged in sexual activity; or
  • in a sexual context; or
  • as the subject of torture, cruelty or abuse (whether or not in a sexual context)
    in a way that a reasonable person would regard as being, in all the circumstances, offensive.Child exploitation material can include any film, printed matter, electronic data, computer image and any other depiction.Before completing this document please read your diocesan policy for selection of ordination candidates, clergy and paid church workers.

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1.

2.

3 a.

3 b.

3 c. 4. 5.

6.

Have you ever, since the age of eighteen, been known by any name other than the one given above?

§ Yes No
Do you have any health problem(s), which may affect your work with children or

young persons?

§ Yes No

Has disciplinary action of any sort ever been taken against you by a licensing board, professional or community association, employer, educational institution, Church or any other body?

§ Yes No
Have there been charges* against you to the above named bodies that did not result

in discipline?
Are there charges* pending against you before any of the above-named bodies?

§ Yes No § Yes No

Have you ever been convicted of a criminal offence?

§ Yes No
Have you ever been charged* with a criminal offence?

§ Yes No
Have you ever been asked to resign or been terminated by a training program,

7.

8 a.

8 b.

9.

10.

11.

12.

§ Yes No
Have you ever had permission to undertake paid or voluntary work with children

refused, suspended or withdrawn in Australia or any other country?

§ Yes No
Have you ever had a civil suit brought against you arising out of alleged professional

misconduct, or is any such pending?

§ Yes No
Have you ever had professional indemnity insurance declined, suspended or revoked

for any reason?

§ Yes No

Have you ever been charged* with having engaged in sexual conduct or attempted sexual conduct with a person with whom you had a pastoral or professional relationship (e.g., a parishioner, a client, a patient, an employee, a student, a subordinate)?

§ Yes No

Sexual conduct includes sexually motivated touch and conversation through to sexual intercourse of any kind. The context of the conduct includes personally, virtually or by any electronic means.

Have you ever been charged* with having engaged in sexual conduct with persons under the legal age of consent?

§ Yes No
Have you ever been charged* with the production, sale or distribution of, or illegal

access to child exploitation material*?

§ Yes No
Have you ever been charged* with an offence related to sexual misconduct?

§ Yes No

Sexual misconduct includes:

  • abuse of power or role for sexual purposes
  • sexual conduct with a person under the age of consent or an adult incompetent togive consent
  • sexual assault (e.g., rape)
  • soliciting for sexual purposes
  • an offence related to child exploitation material* or public indecency (e.g.,indecent exposure)
    Have you ever been charged* with an offence related to sexual harassment?§ Yes No Sexual harassment includes:
  • sexual advances
  • requests for sexual favours
  • sexually motivated physical contact
  • verbal or physical domination of a sexual nature?
    Have you ever engaged in any of the following conduct, even though never having

13.

14.

employer or Church body?

SAFE MINISTRY CHECK – APPLICANT

SAFE MINISTRY CHECK – APPLICANT

been charged*?

  • sexual contact with a parishioner, client, patient, student, employee orsubordinate
  • sexual contact with a person under the age of consent
  • illegal use, production, sale or distribution of child exploitation material*
  • conduct likely to cause harm to a child or young person, or to put them at risk ofharm.§ Yes No

§ The context of the contact and conduct includes personally, virtually or by any

electronic means.

  1. Have you ever been charged* with verbal or physical harassment?§ Yes No
  2. Do you have a history of alcohol abuse?§ Yes No
  3. Do you have a history of substance abuse including prescription, over-the-counter,recreational or illegal drugs?§ Yes No
  4. Do you have a history of problem gambling?§ Yes No
  5. Have you ever been charged* with any offence related to cruelty to animals?§ Yes No
  6. Have you ever been charged* with a traffic offence which required you to attend

court?
21. Has your driver’s licence ever been revoked or suspended?

§ Yes No § Yes No

  1. Have you ever had an apprehended violence order, order for protection or the like issued against you as a result of allegations of violence, abuse, likely harm, harassment, stalking, etc?§ Yes No
  2. Have you ever had a licence to own firearms refused or revoked?§ Yes No
  3. Has a child or dependent young person in your care (as a parent or in any other capacity) ever been removed from your care, or been the subject of a risk assessment by the authorities?§ Yes No
  4. Have you ever been charged* with misappropriating funds, or otherwise breachingfiduciary duties in any capacity?§ Yes No
  5. Have you ever been charged* with an offence under the taxation laws?§ Yes No
  6. Have you ever had an order made against you or entered into a composition with

SAFE MINISTRY CHECK – APPLICANT

creditors or an assignment for the benefit of creditors under the Bankruptcy Act or have you ever had an order made against you under any Act regulating corporations?

§ Yes No
28. Have you done anything in the past or present that may result in allegations being

made against you of child abuse?

§ Yes No Child abuse means:

• the
o bullying;

following conduct in relation to a child:

o emotionalabuse;o harassment;
o neglect;
o physicalabuse;o sexualabuse;

o spiritualabuse;o grooming;or

the wilful or reckless failure to comply with the laws of the Commonwealth, a State or Territory requiring the reporting of child abuse to the police or other authority; or
possession, production or distribution of child exploitation material*.

• the
The context of the conduct includes personally, virtually or by any electronic means.

SAFE MINISTRY CHECK – APPLICANT

ORDINATION (complete if applicable)

I was ordained as a Deacon in the Diocese of on
I was ordained as a Priest in the Diocese of on

I was consecrated as a Bishop in the Diocese of on

RECORD OF BISHOP’S LICENCES OR AUTHORITIES: (complete if applicable)

List any positions where you have previously held a Bishop’s Licence or Authority.

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Position

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Diocese

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Bishop

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RECORD OF CHRISTIAN CHURCH MEMBERSHIP AND CHRISTIAN MINISTRY

List the following information regarding any church you have attended regularly during your adult life, excluding positions detailed above.

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Church

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Position

Location

Senior Minister

Date From Month/Year

Date To Month/Year

SAFE MINISTRY CHECK – APPLICANT

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SAFE MINISTRY CHECK – APPLICANT

RECORD OF EMPLOYERS

Employer

Position

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Location

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Date from Month/Year

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Date to Month/Year

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INTERSTATE / INTERNATIONAL RESIDENCE

Have you ever resided in any other Australian State or Territory, or any other country?

§ Yes No

If YES please list all the countries and states

State or Country

Address

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Dates

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SAFE MINISTRY CHECK – APPLICANT

AUTHORITY TO PROVIDE INFORMATION AND RELEASE FROM LIABILITY OF REFEREES AND OTHERS AND CONSENT TO NATIONAL POLICE HISTORY CHECK AND/OR WORKING WITH CHILDREN CHECK OR WORKING WITH VULNERABLE PEOPLE CHECK

I understand that it is the policy of the Anglican Church of Australia to ask:

  • those who serve or have served as my bishop;
  • churches I have regularly attended as an adult; and
  • my employers;whether to the best of their knowledge I have engaged in specified conduct that is relevant to the assessment of whether I am a suitable person for to undertake ministry in the Church.I have identified all positions in which I have held a bishop’s licence or authority, all churches which I have regularly attended as an adult and my employers. I hereby authorise you and your delegates to contact and exchange information with them. I further hereby authorize every one of those bishops, churches and employers to inform you and your delegates of any knowledge they may have relevant to the assessment of whether I am a suitable person for to undertake ministry in the Church.I hereby authorise my referees to answer the Referee’s Screening Questionnaire and to provide any information relevant to my application to you and your delegates.I hereby release from liability any person or organisation that provides such information. I also agree to release you and your delegates from any and all liability as it relates to any investigation by you or them regarding the information contained in this application, or any action by you or them as a result of such investigation.I hereby consent to provide an Australian Federal Police Check if I have resided in another country. I also consent to provide a Working with Children Check.SignaturePrint NameDate

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I

STATUTORY DECLARATION

SAFE MINISTRY CHECK – APPLICANT

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of
do solemnly and sincerely declare that:

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  1. (1)  the information I have provided in this application and the information contained in any documents accompanying this application are true and correct to the best of my knowledge and belief.
  2. (2)  I understand that any material misstatement in or omission from this questionnaire may render me unfit to hold a particular or any office in the Church or to remain in employment in a Church body.

Applicant’s signature:
Declared at: this

Signature:

WITNESS TO THE APPLICANT’S SIGNATURE Name of Witness:

Address of Witness:

Title / Office held:

Date:
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Your signature must be witnessed by a person (who is not required to read the document) authorised to witness a Statutory Declaration.

IF YOU ARE INVITED to an INTERVIEW, please bring for sighting PROOF OF IDENTITY – two (2) documents, one of which includes a photograph and one of which is either a Birth Certificate, Passport or current Driver’s Licence.

ID sighted ID approved ID not approved

CHARACTER REFERENCE

Please provide three (3) referees. Referees must be over eighteen years of age and be able to give a report on your good character and suitability for ministry among children and young people. They must NOT be a relative, close friend or a member of the Selection panel. If you have lived in another state or country, please include a referee from your last parish or placement in that state and/or country.

REFEREE 1

Name: Address:

State: Country: Email:
Phone: (home)

(Senior Church Leader e.g. rector, church warden, elder)

Clearance for service

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Postcode

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(work)

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REFEREE 2

Name: Address:

State: Country: Email:
Phone: (home)

(Employer or teacher if no work history)

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Postcode

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(work)

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REFEREE 3

Name: Address:

State: Email: Phone:

(Person who has known you for longer than 3 years and knows you well)

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Country:

(work) __________________

Postcode

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(home)

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Reg. 6

Professional Standards Uniform Regulations 2017 (Melbourne)

FORM 3

ANGLICAN CHURCH OF AUSTRALIA DIOCESE OF MELBOURNE

CONFIDENTIAL APPLICATION FOR CLEARANCE FOR SERVICE

under s60 of the Professional Standards Uniform Act 2016 (Melbourne)PERSONAL DETAILS:

Title:
Surname:Christian Names:Previous Names:Address:

Home Phone No:

Male/Female

Clearance for service

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Work Phone No:

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Mobile Phone No: page16image3679852128Email:Date of Birth:

Marital Status:

Occupation:
Drivers Licence number: page16image3679859104expiry date page16image3679860512type:

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(a copy of a current driver’s photo licence issued within Australia must be provided)

or Other Identification:

(a copy of a birth certificate, a current Australian passport, an Australian citizenshipdocument or Australian immigration papers, a current credit card or account card from an Australian financial institution, OR a current student identity card from an educational institution must be provided)

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Applicant’s Screening Questionnaire

The Anglican Church of Australia has established standards of conduct for voluntary church workers to maintain a safe and healthy ministry environment. Our commitment to these standards requires that we conduct background referencing for all persons who intend to engage in voluntary ministry or service having direct and regular involvement with children and young people (0 to 18 years) in Australia.

This request for information is being made to comply with Anglican Church of Australia policies, and not because we have any reason to believe that any applicant has in fact engaged in inappropriate conduct. What follows is our Screening Questionnaire for those who intend to engage in voluntary ministry or service having direct and regular involvement with children and young people in Australia.

This Screening Questionnaire is to be retained by the Office of Professional Standards within Kooyoora Ltd in a secure place. Except as may be required by law, or by church disciplinary or fitness procedures, the information you supply will be used only for screening, fitness and disciplinary purposes. Where required by law, the information you supply will be produced.

You must answer all questions. You should add any additional information under the question or on a separate page. Please note that a yes answer will not necessarily result in your application being unsuccessful.

We do not interpret a yes answer to a question as an admission of misconduct. Each Diocese in Australia provides a formal process for making such a charge.

Thank you for your time. Yours faithfully

Registrar, Diocese of Melbourne

Please return this Questionnaire to:

The Director of Professional Standards Office of Professional Standards Kooyoora Ltd
PO Box 329

CANTERBURY 3124

Clearance for service

APPLICANT’S SCREENING QUESTIONNAIRE

Please tick either “yes” or “no” for each question. If the answer to any of the following questions is “yes”, please give details. A yes answer will not automatically rule an applicant out of selection.

In this document charged* indicates allegations made in writing and known to you OR allegations made to a court, disciplinary tribunal or employer in Australia or in any other country.

In this document child exploitation material* means material that describes or depicts a person who is or who appears to be a child –

  • engaged in sexual activity; or
  • in a sexual context; or
  • as the subject of torture, cruelty or abuse (whether or not in a sexual context)
    in a way that a reasonable person would regard as being, in all the circumstances, offensive. Child exploitation material can include any film, printed matter, electronic data, computer image and any other depiction.Before completing this document please read the diocesan policy for selection of volunteers.
  1. Do you have any health problem(s), which may affect your work with children or young people?Yes “ No “
  2. Have you ever been convicted of a criminal offence?Yes “ No “
  3. Have you ever been charged with a criminal offence?Yes “ No “
  4. Have you ever had permission to undertake paid or voluntary work with children refused,suspended or withdrawn in Australia or any other country?Yes “ No “
  5. Have you ever engaged in any of the following conduct (personally, virtually or by any electronic means)?sexual contact with a person under the age of consent
    production, sale, distribution or illegal use of child exploitation material*
    conduct likely to cause harm to a child or young person, or to put them at risk of harm.Yes “ No “
  6. When in a pastoral or professional relationship, have you ever engaged in sexual contact (personally, virtually, or by any electronic means) with a parishioner, client, patient, student, employee or subordinate (other than with your spouse)?Yes “ No “
  7. Has your driver’s licence ever been revoked or suspended?Yes “ No “
  8. Have you ever had an apprehended violence order, order for protection or the like issued

Clearance for service

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Clearance for service

against you as a result of allegations of violence, abuse, likely harm, harassment, stalking, etc?

Yes “ No “

  1. Has a child or dependent young person in your care (as a parent or in any other capacity) ever been removed from your care, or been the subject of a risk assessment by the authorities?Yes “ No “
  2. Have you done anything in the past or present that may result in allegations being madeagainst you of child abuse?Yes “ No “Child abuse means:
    the following conduct in relation to a child:

o bullying;
o emotionalabuse;
o harassment;
o neglect;
o physicalabuse;
o sexualassault;
o spiritualabuse;
o grooming;or
o thewilfulorrecklessfailuretocomplywiththelawsoftheCommonwealth,a

State or Territory requiring the reporting of child abuse to the police or other authority; or

the possession, production or distribution of child exploitation material*.

The context of the conduct includes personally, virtually or by any electronic means.

11. Have you a history of alcohol abuse or a history of substance abuse including prescription, over-the-counter, recreational or illegal drugs?

Yes “ No “

RECORD OF CHRISTIAN CHURCH MEMBERSHIP

List all church organisations, churches, parishes or congregations of which you have been a member.

er

Clearance for service

Church

Position

Location

Senior Minist

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Date From

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Date To Month/Ye

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Month/Ye

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ar

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ar

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Clearance for service

AUTHORITY TO PROVIDE INFORMATION AND RELEASE FROM LIABILITY OF REFEREES AND OTHERS AND CONSENT TO NATIONAL POLICE HISTORY CHECK AND/OR WORKING WITH CHILDREN CHECK OR WORKING WITH VULNERABLE PEOPLE CHECK

I understand that it is the policy of the Anglican Church of Australia to ask my referees:

whether to the best of their knowledge I have engaged in specified conduct that is relevant to the assessment of whether I am a suitable person for to undertake ministry or service in the Church.

I have identified all church organisations, churches, parishes or congregations of which I have been a member. I hereby authorise you and your delegates to contact and exchange information with them. I further hereby authorise every one of them to inform you and your delegates of any knowledge they may have relevant to the assessment of whether I am a suitable person for to undertake ministry or service in the Church.

I hereby authorise my referees to provide any information relevant to my application to you and your delegates.

I hereby release from liability any person or organisation that provides such information. I also agree to release you and your delegates from any and all liability as it relates to any investigation by you or them regarding the information contained in this application, or any action by you or them as a result of such investigation.

I hereby consent to provide a National Police History Check if I have resided in another country. I also consent to provide a National Police History Check and, for child related work, a Working with Children Check.

Signature

Print Name

Date

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DECLARATION

I
of page22image3680318496do solemnly and sincerely declare that:

Applicant’s signature: page22image3680326096Date: page22image3680326976OR online form of authorisation

For applicants 16 years and under a counter-signature from either a parent or guardian is required.

To the best of my knowledge, the information in this application form is correct.

Signed

Parent or Guardian: Date: page22image3680348192OR online form of authorisation

Clearance for service

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(1)

(2)

the information I have provided in this application and the information contained in any documents accompanying this application are true and correct to the best of my knowledge and belief.

I understand that any material misstatement in or omission from this questionnaire may render me unfit to hold a particular or any role office or position in theChurch.

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REFEREE 1

minister)

Name: Address:

State: Email:

Phone: (home)

(Church leader e.g. rector, church warden, parish councillor, youth

Professional Standards Uniform Regulations 2017 (Melbourne)

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CHARACTER REFERENCE

Please provide two (2) referees. Referees must be over eighteen years of age and be able to give a report (by telephone only) on your good character and suitability for ministry among children and young people. Referees will be contacted by telephone. They must NOT be a relative or a close friend. If you have lived in another state or country, please include a referee from your last parish or placement in that state and/or country.

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Country: page23image3683190192Postcode:

(work)

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REFEREE 2 (Employer or teacher if no work history or adult person who has known you for longer than 3 years and knows you well)

Name:

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Address:

State:

Email:
Phone: (home)

Country:

Postcode:

Professional Standards Uniform Regulations 2017 (Melbourne)

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(work) __________________

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Professional Standards Uniform Regulations 2017 (Melbourne)

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Professional Standards Uniform Regulations 2017 (Melbourne)

FORM 4

Reg. 6

TO: The Secretary
Professional Standards Board

The Professional Standards Committee refers the following matter to the Professional Standards Board pursuant to section 69 of the Professional Standards Uniform Act:

Description of complaint/application:

Attached is a written report of its investigation and opinion signed by a member of the Professional Standards Committee.

Signature— Date—

REFERENCE TO THE PROFESSIONAL STANDARDS BOARD

under s 69 of the Professional Standards Uniform Act 2016 (Melbourne)

__________________

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Reg. 7

Professional Standards Uniform Regulations 2017 (Melbourne)

FORM 5

APPLICATION FOR REVIEW OF A DECISION

under s 89 of the Professional Standards Uniform Act 2016 (Melbourne)

Professional Standards Uniform Regulations 2017 (Melbourne)

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TO: The Secretary
Professional Standards Review Board

Name of applicant— Address—

I APPLY to the Professional Standards Review Board for review of the following decision of the Professional Standards Board—

  1. The decision is—
  2. Date of decision—

My reasons for making the application are—

Signature— Date—

__________________

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