Member in Discernment Application

I authorize the Northern California Nevada Conference of the United Church of Christ and/or its officers, committees, and agents to make inquiries regarding my character and qualifications. I also authorize all entities, persons, seminary staff and faculty, former employers, supervisors, counselors, psychological testing agencies, ministers, ecclesiastical authorizing bodies of other judicatories, settings of other denominations, courts, law enforcement, and other public agencies to respond to inquiries concerning me and to comment on and state opinions regarding my background, character, and qualifications. To encourage such persons to speak openly and responsibly, I hereby release them from all liability arising from their responses, comments, and statements, including, but not limited to, any liabilities for alleged defamation of character or invasion of privacy. I authorize the Northern California Nevada Conference and its agents to circulate, distribute, and otherwise share the information gathered regarding me to those whom it, in its sole discretion, deems adviseable.

All candidates requesting in Discernment status with the Conference must give permission for a criminal background screening. This information will be kept strictly confidential and interpreted alongside an individual's Personal Disclosure Statement. This screening DOES NOT take the place of the mandatory criminal background check required to circulate a Ministerial Profile in the United Church of Christ. Your personal information in the rest of this application, along with your Social Security Number, will be used to conduct a criminal background check. You will be charged $13.25 and payment by credit/debit card will be collected now.

I declare all of the above to be true under penalty of perjury, as of the date and time of my submission of this form.