THE SYNOD OF THE DIOCESE OF WEST MALAYSIA (ANGLICANCHURCH)
214, Jalan Pahang, 53000 Kuala Lumpur
Tel: 03-4024 3213, 40253213 Fax: 03-4032 3225
E-mail:
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APPLICATION FORM TO BE CONSIDERED FOR
Priest (Full-Time) Priest (NSM/LOM) Lay Reader
Deaconess (Full-Time) Deaconess (Hon) Studying at STM
Evangelist Lay Pastor ______
1.Name in Full : ………………………………………………………………………………….…….……
2.IC No. (New) ………………………….…… (Old) ………………………..…… Age ……..…….…
(Please enclose a copy)
3.Sex : ……………………… 4. Marital Status : …………………… 5. Race: ……………………….
6.Correspondence Address : ……………………………………………………………………………..…
………………………….……………………………………………………………………………………..
7.Residence Address : ………………………………………………………………………….…….……..
………………………….……………………………………………………………………………………...
8.Tel. No. H/P : …………….…..……….… House : ………..…………….. Off : …………...………...……
9.E-mail Address : ……………………………………………...………...... …………..……...
10.Languages Spoken : …………………………………………………………..…………………………..
11.Languages Written : …………………………………………………………………………………..……
12.Date and Place of Baptism : ……………………………………………………………………..………..
(Please enclose copy of certificate)
13.Date and Place of Confirmation: ………………………………………………………….……………..
(Please enclose copy of certificate)
14.Name and Address of church where you presently worship: ………………………..…..…………..
…………………………………………………………………………………………………………………
15.Positions held in church:-
ResponsibilityPeriod
1. ………………………….……………………………………………………………………..…………...
2. …….…………………………………………………………………………………………..…………...
3. ……………………….………………………………………………………………………..…………...
4. …….………………………………………………………………………………………..……………...
16.Completed course on Anglicanism: Yes / No
(Please enclose copy of certificate)
17.Completed Lay Reader’s Course: Yes / No
- Give details of church or social work you are currently doing or have already done and any office
held. Include any specific training and qualifications obtained for church work.
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19.ACADEMIC HISTORY
School/College/University / Language of
Instruction / Year / Standard passed/
Qualification / Area of Specialization
(Tertiary Education)
LCE / SRP / PMR
MCE / SPM
HSC / STPM
(Details of results/qualifications and certified true copies of all certificates must be enclosed
with this application)
20.WORKING EXPERIENCE
Employer / Type of work / Period of Employment21.Give details of money, if any, owing to the Government or other organisations, for scholarships,
loans or any other liabilities.
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22.Please include the following on separate pages, each not more than 500 words:
a)Your reason for applying this position
b)Your conversion experience
c)Your call to ministry
d)Brief description of self, family and church involvement
e)Recommendation letter by priest-in-charge / vicar
f)Recommendation letter by local MDC / PCC with relevant extract of meeting minutes
23.Name/Contact of Two Referees (non-family members):
a)Name: ………………………....b)Name: ………………………….
Occupation: ………………………....Occupation: ………………………....
Tel. No: ………………………....Tel. No: ………………………....
E-mail add: ………………………....E-mail add: ………………………....
24.Only for Lay Reader applicants: Please specify the licence applied for:
A)Reading Services
B)Assisting in Holy Communion
C)* Preaching* please enclose 3 sets of your sermon notes.
25.For Lay Pastor applicants, please mention the area of ministry you will be in-charge of as a Lay Pastor.
………………………………………………………………………………………………………………………..
Date : …………………………………Signature of applicant : ……………..…….…….…………
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Note: This application will not be valid unless certified true copies of all relevant documents (certified as true copies of the original, by the priest ) and all information requested in item 22 above are enclosed together with this application form. If any original document is unavailable, a Statutory Declaration on its status must be sent together with this application.
Revised in July 2016