Application Order Number Full Name Email Address * Mailing Address City State/Province - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Phone Number Date of Birth Social Security Number Sacramental Information Baptized? Yes No Confirmed? Yes No Marital Status Single (Never Married) Single (Divorced) Married Committed Widowed Other Date of Marriage Spouse's Name Do you have children? Yes No Have you ever taken vows in another order? Yes No If yes, please explain Are you interested in living in community? Yes No Past Summary Are you now being, or have you ever been, treated for a chronic physical, mental, or emotional illness? Include experience with 12 step recovery programs. Yes No If yes, please explain: Do you have any significant debts or financial uncertainties? Yes No If yes, please explain: Excluding minor traffic violations, have you ever been convicted of a felony or misdemeanor (including suspension or withdrawal of Driving License)? Yes No Explain to the best of your ability the conviction and final outcome. Have you ever been accused of any crimes involving children or crimes of a sexual manner (rape, incest, molestation, emotional abuse, domestic violence ect.)? Yes No When, why and what was the outcome of the investigation. Have you ever used, abused, or been addicted to illegal drugs or narcotics; abused over-the-counter or prescribed drugs or medication; or been treated for drug or alcohol abuse and dependency? Yes No Please provide a brief explanation, including dates, usage, and treatment received if any. Have you ever been involved in any public scandal, or allegations that were covered by the press? (If you have, it may not disqualify you from ordination, but we need to know about it, and we do not want to hear about it from a third party. It is in your own interest to tell us, and supply any press cuttings etc. It is for your protection and ours that we need to be fully informed) Yes No If yes, please explain. Acknowledgements If accepted as a candidate in the OSFoc, do you hereby solemnly affirm that you will comply with and conform to the canons and codes of conduct? * Yes No Do you hereby solemnly affirm that you will submit to the guidance, leadership and authority of your Bishop Ordinary and the College of Bishops? Yes No Do you hereby solemnly affirm that you will not engage in any activity that is or could be interpreted as, schismatic, scandalous, divisive, abusive, discriminatory, or disrespectful? * Yes No Do you hereby solemnly affirm that you will respect the opinions and practices of other Christians, parishes, and clergy even though you may not personally agree; and that you will strive for unity, and respect the dignity of all God’s People? * Yes No I acknowledge that the OCCI ordains women to all ranks of clergy and ordains homosexuals to all ranks of clergy. * Yes No I acknowledge that the OCCI does bless same-sex unions and has no policy of discrimination against any human being for any reason. * Yes No Do you understand that the OCCI does not provide stipend, recompense or remuneration for its clergy and others, nor does it financially support such missions or churches; and that you will need either to hold secular employment, or live by the grace and generosity of your mission, church, or program? * Yes No Initial the following: The undersigned, an applicant for Holy Orders in the Old Catholic Churches International, give my permission to the Commission on Ordained Ministry to share reports of my physical examination, and my psychological examination, my psychological evaluation, along with my applications for Nomination, Postulancy, Candidacy, to be ordained Deacon, Priest or Bishop and all supporting material supplied by me or my parish or other community of faith with the Commission on Ordained Ministry of the OCCI, Deacon, Priest or Bishop Mentors appointed by the Commission on Ordained Ministry, and the College of Bishops and Vicars. I further give my permission to the psychological examiners, psychological evaluators and medical examiners to exchange information about me with each other for the purposes of a full and comprehensive assessment of me for Holy Orders. I understand that the results and reports of the psychological examinations, the psychological evaluations and the medical examinations are the property of the OCCI and are subject to the rules of the OCCI for management of personal information, and may be utilized pursuant to agreements between me and the OCCI. I further agree that the OCCI’s psychiatric or psychological evaluator will be held harmless in any action associated with the management of information gathered in the evaluation process. I understand and agree that written reports of my medical examination, psychological or psychiatric examination and psychological evaluation will be sent directly to the Presiding Bishop of the OCCI or his other designees and these reports will remain a part of my permanent record with the OCCI. Signature * Today's Date
