Michigan Conference of the United Methodist Church
Board of Ordained Ministry
Background and Credit Check Authorization Form
The United Methodist Church (UMC) requires criminal background and credit checks for all those seeking
appointments in the UMC. Per The Book of Discipline of the United Methodist Church – 2016, everyone who
applies for Certified Candidacy (⁋310.2.b), License for Pastoral Ministry (⁋315.6.a), Provisional Membership
(⁋324.12), or transfer from another denomination (⁋347.3), is required to complete these reports.
Please complete the information below:
I hereby authorize a First Advantage Background and Credit Check and an MSP-iCHAT Screening, on behalf
of the Michigan Conference, to procure a consumer report which I understand may include information
regarding my credit worthiness, credit standing, credit capacity, character, general reputation, personal
characteristics, or mode of living. This report may be compiled with information from credit bureaus, court
record repositories, departments of motor vehicles, past or present employers and educational institutions,
governmental occupational licensing or registration entities, business or personal references, and any other
source required to verify information that I have voluntarily supplied. I understand that I may request a
complete and accurate disclosure of the nature and scope of the background verification; to the extent such
investigation includes information bearing on my character, general reputation, personal characteristics or mode
of living.
_______________________________________________
Applicant Signature
(If submitting by email, typed full legal name is accepted.)
_______________________________________________ ________________________________________
United Methodist Church District
(where your membership is held)
Today’s Date ___________________________________
Current Legal Name _________________________________________________________________________
First Middle Last
How long have you had the current legal name listed above? _________________________________________
If applicable, please provide your maiden name
_________________________________________________________________________________________
First Middle Last
If applicable, please provide any other previous legal name(s):
First, Middle, Last __________________________________________________________________________
First, Middle, Last __________________________________________________________________________
Gender: ________________________________________ Ethnicity: _________________________________
Email: _________________________________________ Phone: ___________________________________
Email: _________________________________________ Phone: ___________________________________
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