Metropolitan Community Church of Rehoboth Beach Making Christ's

b. Employer Name

Phone

City/State/Zip

Website

Type of Business

Supervisor's Name

Dates of employment (month/year to month/year)

to

Monthly Pay

Title/Position

Years of Service

Major Responsibilities

May we contact this employer for a reference?

YES

NO

Answer the following questions if you hold or have even held any type of professional license:

Have you even been licensed/certified for any profession?

YES

NO

If yes, name the license/certification for each:

Issuing State:

License/Certification Number:

Was any license/certification ever revoked or suspended for any reason?

YES

NO

If yes, state the reason(s), date of revocation or suspension, and date of reinstatement, if any:

Have you ever left a job involuntarily? If yes, please explain.

YES

NO

5. previous criminal or civil liability

The questions in this section are designed to help the Church make an informed decision concerning an application for a ministerial position. False or incomplete answers will be grounds to remove an applicant from further consideration or to dismiss from employment an applicant who has been hired.

1. Have you ever been convicted of, or pled guilty or "no context" to, any felony or misdemeanor other than minor traffic violations or convictions for marijuana-related offenses that are more than two years old?	YES	NO
If yes, explain fully on a separate sheet (identify each conviction or plea, when and where the conviction or plea occurred and the sentence received).
2. Have you ever been found liable, or participated in an out-of-court settlement as a defendant in any civil lawsuit?	YES	NO
If yes, explain fully on a separate sheet (identify each case number, court, when and where incident occurred, and the verdict rendered or result of the settlement).
3. Have you ever been accused of or investigated for sexual misconduct? (Note: The term "sexual misconduct" here refers to the definition of sexual misconduct of clergy adopted by the General Conference of the Universal Fellowship of Metropolitan Community churches in July 1995 and is attached to this application.)	YES	NO
If yes, explain fully on a separate sheet (identify when and where each accusation was made and how each accusation was resolved).
4. Have you ever been the subject of disciplinary action by an employer or licensing organization alleging sexual or ethical misconduct?	YES	NO
If yes, explain fully on a separate sheet.
5. Have you ever been the subject of ecclesiastical discipline by a church or denomination?	YES	NO
If yes, explain fully on a separate sheet.