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If the applicant will be locum while you are on a combination of leave, eg Annual and Long Service leave, please indicate the start and end of the total leave, not just the Long Service leave.Start date: FORMTEXT      End date: FORMTEXT      The applicant will be working  FORMTEXT       day/s per week.StipendThe applicant will be paid a stipend not less than the minimum stipend recommended for that position, ie $ FORMTEXT       per day.Benefits FORMCHECKBOX  Travelling allowance in accordance with diocesan scale  FORMCHECKBOX  Travel benefit in lieu  FORMCHECKBOX  Housing providedUndertaking by IncumbentIn the event of my not returning and resuming my duties by the above end date, provided that no extension of leave is granted, or I am hindered by illness, or other reasonable cause, I hereby authorise the Archbishop of Sydney for the time being, or his Commissary, to declare my cure vacant, in order that another incumbent may be appointed. Signature: Date:  FORMTEXT      Privacy Certification by applicantI consent to the information that has been provided on this form being collected, used and disclosed by the Archbishop s office for the purpose of that office and in particular to license me to the above positi@ln   8 : < P R T ^ ` b d ֽseWjh'5U\h!Lh'6CJ]aJh!LhQ6CJaJhQ jh'5U\mHnHujh'5U\ h'5\jh'5U\h'6CJ]jh'UmHnHujh'Ujh'U h!Lh'h!LhQ] h'CJh'OJQJ\h'">@lnuoi$If$Ifxkd$$Ifl4TI(  064"4 l4af4p  7&$IfFF $Ifykd9$$IflT0 I( 064"4 l4a  : b $Ifykdc$$IflT0 I( 064"4 l4ab d  P  }pppp d8$If d8$Ifykd$$IflT0 I( 064"4 l4a   . 0 2 P R n p r   & ( * , D F Z \ ^ h j n p xjjh'UmHnHujh'Ujh'U h'@h'h'6CJ]jh'CJUmHnHujh'CJUjh'CJUj/h'CJUjh'CJUjCh'CJU h'CJjh'CJU)  & ( w $$Ifa$$Ifykd$$IflT0 I( 064"4 l4a( * , D l ss $d$Ifa$$IfzkdS$$Ifl40 I( 064"4 l4af4l n p `ZNN $d$Ifa$$Ifkd$$Ifl4F ~I(Gu 06    2q2q2 l2q4"4 l4af4 <>N"$8:<FHRhz|˿˿|l|`jh'CJU^Jjh'6CJU]jh'6CJU]j h'>*CJU!jh'>*CJUmHnHujt h'>*CJU h'>*CJjh'>*CJU h'CJh'6CJ]jh'UmHnHuj h'Uh'jh'U# <icW $d8$Ifa$$IfkdW $$Ifl4F ~I(Gu 06    2q2 l4"4 l4af4<>Nfzqe $d8$Ifa$ d8$Ifkd $$Ifl4T0 I( 062q2 4"4 l4af4fhz/R}o__$ d8$Ifa$ Td8$If d8$Ifykd[ $$IflT0 I( 064"4 l4a/0>?@QSlm  Z\> >>6>8>L>ȸȡnȫg`ZXZȡU h'aJ h'5\ h'6]&jh'CJU^JaJmHnHu!jh'CJU^JaJjh'CJU^JaJh'CJ^JaJh'h'6CJ]h'56CJ\]^JaJ h'CJj h'CJU^Jjh'CJU^Jjh'CJU^Jh'CJ^J"RSl} $$Ifa$ykd$$IflT0 I( 064"4 l4almt $d$Ifa$ d$IfukdE$$IflTI(  064"4 l4ap  $$Ifa$$Ifjkd$$IflTI(062q4"4 l4aNE $$Ifa$kdS$$IflT\.I(5n ^062 D2 D2 D2 D4"4 l4aZ $$Ifa$fkd$$IflI(064"4 l4aZ\ > >w $$Ifa$ d$Ifukdi$$IflTI(  064"4 l4ap on. Signature: Date:  FORMTEXT      A copy of the Archbishop s office Privacy Statement can be found at http://www.sds.asn.au/site/103311.asp* Please note that you will need your Regional Bishop s approval if you intend travelling overseas while on leave. This application needs to be fully completed by the incumbent and applicant and returned to the Diocesan Registry before the incumbent goes on leave. The Working with Children Check (Attachments 4 & 5) need to be completed by the applicant and returned to the Registry as soon as possible. A 100 points check is now required for all background checks (Attachment 5). Please refer to the sheet  100 points identity check . If the applicant is a clergyman from outside the Diocese of Sydney, this will need to be approved by your Regional Bishop. The necessary Oath and Declarations and a confidential questionnaire will need to be completed by the applicant at an interview arranged with the Regional Bishop. Please return this form fully completed and signed to: Diocesan Registry, PO Box Q190, QVB Post Office NSW 1230     5/07 >>&>(>6>^> $$Ifa$$Ifjkd6$$IflTI(062q4"4 l4aL>N>P>Z>\>^>`>>2?4?6?AAAAAANB`BhCjClCE`>4?NA ddP$Ifkdw$$IflT\.I(5n ^062 D2 D2 D2 D4"4 l4a4?6?@lCE4"4 l4aFFFFFFFFFFFFF h'CJh/ h/CJhgjhgU 6&P 1h:p!L. 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