PEACHY

PEACHY Certification Renewal Form

Use this form if you currently have PEACHY certification and wish to renew it. Certifications must be renewed annually by August 31. If you are not currently certified, please use the PEACHY ministry application form instead.

Name Required

Name used on previous PEACHY application, if different

List any new address changes since your previous application

List any phone or email changes since your last application

Where are you a church member? (If not FBCK, include church name and city/state. If not a member of any church, respond "NONE".) Required

Legal

Have you at any time ever beeen convicted of, or pled guilty to or no contest to, any crime? (do not include minor traffic citations or civil judgements) Required

Yes

Have you at any time ever participated in, or been accussed, convicted, or pleaded guilty or no contest to abuse or any sexual misconduct? Required

Yes

Are you aware of any traits or tendancies that could pose any threat to children, youth, or others? Required

Yes

Are you aware of any reason why you should not work with children, youth, vulnerable adults, or others? Required

Yes

If the answer to any of these questions is "Yes", please explain in detail. If the incident was documented in a previous application, respond "See previous application" instead.

Verification and Release

I recognize that First Baptist Church of Kingstowne (FBCK) is relying on the accuracy of the information I provide on this application form. Accordingly, I affirm that the information I have provided is true and correct.

I authorize FBCK, or its agents, to contact any person or entity listed on this application form, and I further authorize any such person or entity to provide FBCK, or its agents, with information, opinions, and impressions relating to my background or qualifications.

I voluntarily release FBCK, or its agents, and any such person or entity listed on this application form from liability involving the communication of information relating to my background or qualifications.

I have read the policy and procedures of FBCK, and I agree to abide by them. I understand that failure to follow procedures could result in dismissal from ministerial roles. I agree to protect at all times the health and safety of infants, children, youth, or vulnerable adults assigned to my care or supervision.

Today's date Required

By clicking on "Submit", I so affirm.