PBC Screening Form 2023 • Parramatta Baptist Church

Please Note: This is a sensitive document that will be stored in a confidential manner accessible only by a limited number of authorised persons.

Before completing this form, you should have submitted a completed Code of Conduct form (here) and a referee form (here).

If you are logged in to Elvanto, some fields will pre-populate for you. If you would like an Elvanto login or need your password reset, contact admin@parramattabaptist.com.

If you have any issues, please contact ops@parramattabaptist.com.

Personal details

First Name *

Last Name *

Date of Birth *

Are you 18 years of age or older? *

Yes

Mobile Number *

Email Address *

Legal full name *

WWCC Number (only if required - check with your Ministry leader)

Home Address *

Home Address Line 2

Post Code *

Home City *

Home State *

List any churches you have attended regularly in the past 3 years (Church name, location, month/year attended, positions held) *

Tip: e.g. PBC, Northmead, 2018-present, no roles (one line for each church). If none, write "none".

Screening Questions

Have you ever been charged with and/or convicted of a criminal offence? *

Yes

To your knowledge, has there ever been any allegations made against you regarding any abuse of a child, physical abuse or sexual misconduct? *

Yes

Have you had a history of alcohol abuse or substance abuse (including prescription, over the counter, recreational or illegal drugs)? *

Yes

My consent

I understand that this information will be kept in a confidential file and used only for screening purposes. *

Yes

I consent to the information contained in this application, including any subsequent pages, to be kept by our church. *

Yes

18+ consent

I consent to verification of my legal name and/or WWCC number (if required, 18+ only) *

Yes

I consent to a National Police Check (for staff only) *

Yes

N/A

Declaration

I, *

Tip: type in your full name

hereby declare:

The information I have provided in this application is true and correct to the best of my knowledge and belief;

I understand that if I provide false or misleading information or withhold relevant information from this questionnaire, the church leadership may determine that I am unsuitable to serve in any role in the church;

I received, read and agreed to the Code of Conduct and am willing to uphold it;

I have provided details of two referees who are over eighteen years of age and able to give a written or verbal report on my character and suitability for ministry.

Date of Declaration *

Declared *

By marking this box and submitting this form I agree and make the declaration above on the date shown.

If you are a parent/guardian completing this form on behalf of a child under 16, please enter your name

Safe Ministry Screening Questionnaire

Personal details

Screening Questions

18+ questions

My consent

18+ consent

Declaration