Note any specific training you may have taken
I Have been accused or convicted of a criminal offence involving children
I Have been accused or convicted of a sexually related crime
I Have been accused or convicted of an abuse related crime
I Have been hospitalized or treated for alcohol or substance abuse
I Have any communicable diseases
I Have recently been experiencing mental instability
Please include the Name of the Church, Dates & Description of Ministry, your Ministry Supervisor and a phone number for them.