CERCC THE CHAPLAINS CORPS APPLICATION
OFFICIAL APPLICATION FOR CRECC MEMBERSHIP
Certified Emergency Response Chaplains Corps, International
Commander John D. Butler
P.O. Box 3332
Kinston, NC. 28502
(Please know that it can take two to three weeks to process your application.)
IMPORTANT INFORMATION:
-All information submitted is strictly confidential and will be
used only for application processing.
-To apply for membership in the Emergency Response Chaplains
Corps, you must be 18 or older and a CHRISTIAN, and a law
abiding citizen of any country in the world.
-Membership in the Emergency Response Chaplains Corps is
restricted to those who are Christians: those who profess Jesus
Christ as their personal Lord and Savior, regardless of which
Christian denomination or Catholic faith you may be members of.
The ERCC and its members minister to all faiths and even
those who have no faith who may be in need, regardless of their
religious affiliation.
-ERCC is a ministry of Presence. Your actions and being there
for someone in need, speaks louder than words. A chaplain
often stands by a person or family while others might make a
quick visit and then leave them. A chaplain realizes that just
being there for that person who is sick, suffering or even dying
is a ministry also.
-Chaplain ministry is street ministry, where the needs are
constant and it is not so much what you say that makes a
difference as to how you minister, by just being there, like a
solider on watch. Jesus asked his disciples: “Can you not watch
with me for one hour?" The impact that you may have on a life
is that you where there when they were in need and you did not
forsake them.
By submitting this application, you are verifying that all information given is true
and that you are giving Emergency Response Chaplains Corps International permission
to do a criminal background check and to check for nationwide criminal records on you.
Incomplete or fraudulent applications will be dismissed. .
OFFICIAL APPLICATION FOR MEMBERSHIP IN THE ERCC
DATE: ___/___/____
NAME (LAST, FIRST, MIDDLE): _________________________________________________
ADDRESS: ______________________________________________
CITY: __________________________________________________
STATE: _______________________________________
ZIPCODE: ____________________
PHONE: ______________________________________
STATE ID/DL CARD#: __________________________
ISSUING STATE: ____________________
ID/DL EXP. DATE: ____________________________
DATE OF BIRTH: ___/___/_____
GENDER (CIRCLE ONE): MALE FEMALE
EYE COLOR: ________________
HAIR COLOR: ________________
HEIGHT: ______
WEIGHT: ______
MARITAL STATUS (CIRCLE ONE):
SINGLE MARRIED SEPARATED DIVORCED WIDOWED
CURRENT MILITARY STATUS: ______ACTIVE ______RESERVE ____NATIONAL GUARD
BRANCH (CIRCLE ONE): ARMY NAVY MARINES AIR FORCE
DATES OF SERVICE: ENTERED: __________
PRIOR MILITARY SERVICE/VETERAN STATUS:
______ACTIVE ______RESERVE ____NATIONAL GUARD
BRANCH (CIRCLE ONE): ARMY_____NAVY_____ MARINES____AIR FORCE____
DATES OF SERVICE: ENTERED: __________ DISCHARGED: _______________
DID YOU RECEIVE AN HONORABLE DISCHARGE? YES____NO____
IF NO, PLEASE EXPLAIN: ____________________________________________________
PRIOR LAW ENFORCEMENT: YES____NO____
DATES: ___________________________________________
LOCATION/POSITION: ___________________________________________
PRIOR EMS/EMT/FIREFIGHTER: YES____NO____
DATES: ___________________________________________
LOCATION/POSITION: ___________________________________________
ORDINATION HISTORY (IF APPLICABLE)
ARE YOU AN ORDAINED/ LICENSED MINISTER OR CHAPLAIN? (CIRCLE ONE) YES____NO____
IF YOU CIRCLED “YES”, PLEASE SUPPLY THE FOLLOWING:
DATE OF ORDINATION: _______________________
CHURCH/ORGANIZATION THAT ORDAINED YOU: _______________________________
CONTACT PERSON FOR VERIFICATION: _______________________________
CONTACT PHONE NUMBER FOR VERIFICATION: _______________________________
(PLEASE NOTE THAT YOU WILL BE REQUIRED TO SUBMIT COPIES OF THE CERTIFICATES
AND DOCUMENTS THAT ESTABLISH OFFICIAL ORDINATION)
CURRENT OCCUPATION/EMPLOYMENT: __________________________________________________
LIST ALL DEGREES RECEIVED FROM ACCREDITED SCHOOLS:
1. DATE: ______________ SCHOOL: _____________________________
DEGREE RECEIVED: _________________________________________
2. DATE: ______________ SCHOOL: _____________________________
DEGREE RECEIVED: _________________________________________
3. DATE: ______________ SCHOOL: _____________________________
DEGREE RECEIVED: _________________________________________
4. DATE: ______________ SCHOOL: _____________________________
DEGREE RECEIVED: _________________________________________
5. DATE: ______________ SCHOOL: _____________________________
LIST ALL FELONY CONVICTIONS AND/OR SEXUAL CRIMES (PLEASE BE HONEST
WHEN FILLING OUT THIS SECTION BECAUSE A THOROUGH AND COMPLETE
BACKGROUND CHECK IS CONDUCTED ON ALL APPLICANTS)
1. DATE: ___________ CITY/STATE: ______________________________
CHARGE: ___________________________________________________
DISPOSITION: ____GUILTY ___NOT GUILTY
2. DATE: ___________ CITY/STATE: ______________________________
CHARGE: ___________________________________________________
DISPOSITION: ____GUILTY ___NOT GUILTY
3. DATE: ___________ CITY/STATE: ______________________________
CHARGE: ___________________________________________________
DISPOSITION: ____GUILTY ___NOT GUILTY
Your application will not be processed unless it is completed in full, signed, dated, and all required
documents are attached. Submit the following documents with your application:
1. Two Letters of Reference. Must be from someone that has known you for at least three years.
References may be current or past employers, pastors, neighbors, co-workers and fellow volunteers.
References may not be family members. Letters must comment on your character and reliability.
Your reference must also provide their phone number and email address.
2. Ordination Documents (If Applicable) Submit copies of all certificates and letters documenting Christian ordination.
3. Two Passport Photos. Must be original passport photos –
not copies
4. A VALID Copy of Your Driver’s License or Photo ID Card
5. Resume. Provide a resume of your work experience,
education, training, ministry experience and what you hope
to accomplish as a member of the ERCC.
Include copies of degrees, certifications and licenses
applicably to ministry.
Statement of Understanding
“I hereby certify that the above information is true to the best of my knowledge. I understand that
the Emergency Response Chaplains Corps (ERCC) and its affiliate ministries rely on this information
to approve membership, license, endorsement and ordination. I acknowledge that any significant and
material misstatements made by me will be just cause to deny or void my membership. I hereby agree
to abide by all ERCC terms of membership. I understand that the ERCC is dedicated to honesty, integrity
and accountability. I understand that I am solely responsible for my actions and that the ERCC will hold
my accountable for my conduct and any instances of moral turpitude.”.
Membership into the ERCC is the same for everyone.
There is a one-time donation for your application
of $100.00 to become a member of Emergency Response Chaplains Corps.
1.Your application will come with 4 ERCC shoulder patches
2. A photo ID card
3. One basic chaplain course.
4. A course on Ethics
5. A course on the Hippa Law
6. A course on Volunteer Liability
7. A Certificate of Chaplaincy if you are already a legally ordained minister
Recognized by IRS.
You can also make a monthly commitment as the Holy Spirit leads
you if you choose to do so of your own free-will.
I also agree to donate this amount monthly:________________
Applicant’s Signature: _______________________________________
Date: ____________________
Please print this application and postal mail it, it into a word document and send it to the
postal address below:
Or if you know how you can copy and paste this application into pdf or word format and
then fill it out and email the application as an attachment to my email address below.
Email: commanderbutler@gmail.com
Postal mail:
Certified Emergency Response Chaplains Corps
Commander (Gen) John Butler
P.O. Box 3332
Kinston, NC.28502-3332
USA
