Pre-Application to become a Chaplain – Police Chaplains of Philadelphia 18th District

First Name *

Middle Name

Last Name *

Suffix

Gender *

Male
Female

Date of Birth *

Email *

Cell Number (enter numbers only) *

Address *

City *

State *

Zip *

Currently employed as *

If retired, enter previous employment. If still working, enter "none" *

Secondary Contact Name *

Relationship *

Phone (enter numbers only) *

Were you ever a Philadelphia Police Chaplain? *

Yes
No

If you answered "yes", explain what happened. If "no", write "none" *

How did you hear about the Philadelphia Police Chaplaincy? *

What do you believe are the duties of a Philadelphia Police Chaplain? *

Why do you want to become a Philadelphia Police Chaplain? *

Are you willing and able to spend approximately $300 in your first three months for your basic uniform and ID items? *

Yes
No

Are you willing and able to spend an additional $700 in the following three months for your official uniform and the like? *

Yes
No

There may be official training in addition to OTJ that may involve cost and travel, are you willing and able to do so within your first year? *

Yes
No

Would you be willing and able to commit to the required monthly dues ($20) and meetings? *

Yes
No

Are you a(n) *

Ordained Christian Minister
Muslim Imam
Jewish Rabbi
Other

If other, explain or answer "none" *

With what organization are you affiliated? If none, answer "none" *

Have you ever been arrested/convicted of a crime? *

Yes
No

If you answered "yes", below enter the number of Felonies / Misdemeanors. If you answered "no", simply enter "none". *

Enter the first non-related reference: Full name and phone number *

Enter the second non-related reference: Full name and phone number *

Enter your first choice for a meeting (one to two weeks from today) *

Please enter a time *

Enter your second choice for a meeting (one to two weeks from today) *

Please enter a time *

Affixing my name below validates that all information entered is true and accurate. I understand any misstatements can nullify this application and potentially eliminate my chance of further consideration to the applied position. *