Application Form Lay Pastoral Assistant – This form is to be completed for each person applying to become a Lay Pastoral Assistant. The completed form should be signed by the incumbent and the applicant. Details will be kept on the diocesan database. Name of Applicant: Address: Postcode: Telephone: E-mail address: Parish/Benefice/LMG: PCC Approval of the Applicant Date Approved: Safer Recruitment policy followed and Yes No completed Yes No Children Adult Yes No Adult & ENHANCED DBS Certificate Yes No Children Number: Issue Date: Confidential Declaration (completed and Date Signed: signed) Data Protection Notice (completed and Yes No enclosed) Date: Ministry for Mission LPA Training completed Details: (or appropriate training) Copy of the Ministry Specification enclosed Yes No Incumbent LPA Applicant Signed: Name in print: Date:
Application Form – Lay Pastoral Assistant This form is to be completed for each person applying to become a Lay Pastoral Assistant. The completed form should be signed by the incumbent and the applicant. Details will be kept on the diocesan database. Name of Applicant: Address: Postcode: Telephone: E-mail address: Parish/Benefice/LMG: PCC Approval of the Applicant Date Approved: Safer Recruitment policy followed and completed Yes No ENHANCED DBS Certificate Children Yes No Adult Yes No Adult & Children Yes No Number: Issue Date: Confidential Declaration (completed and signed) Date Signed: Data Protection Notice (completed and enclosed) Yes No Ministry for Mission LPA Training completed (or appropriate training) Date: Details: Copy of the Ministry Specification enclosed Yes No Incumbent LPA Applicant Signed: Name in print: Date:
Application-Form-New-LPA-v2.docx