Credential Review Form 2021

Due Date: 28th February 2021

In order to complete this form you will need to upload:

1) A copy of your State issued 'Working With Children' check, and

2) An updated colour photograph of yourself, similar to what you would submit for a passport application, for printing on your Credential Card (This step is optional, however if your photo is more than 5 years old please submit an updated photo).

Please ensure these items are readily available for upload prior to commencing the form.

Which ACC Credential do you currently hold?*

OMCPMCSMC

In which State?*

Please select

Are you a member of the ACC Pastors Emeritus Network, who has retired and held an OMC for more than 10 years?

YesNo

Please specify SMC Ministry

Pastor's ID*

Prefix

Name*

First NameLast Name

Preferred Name

Gender*

FemaleMale

Date of Birth*

DayMonthYear

Are you of Aboriginal and/or Torres Strait Islander origin?

YesNo

E-mail Address*

Confirmation Emailexample@example.com

Has your marital status changed since your Credential/Certificate was last renewed?*

YesNo

Please describe the change to your marital status.

Are you currently married?*

YesNo

Spouse's Name

Spouse's Date of Birth

DayMonthYear

Postal Address*

Street Address

Street Address Line 2

SuburbState

PostcodeCountry

Do you have a different Residental Address?*

YesNo

Residential Address

Street Address

Street Address Line 2

SuburbState

PostcodeCountry

Work Phone*

Mobile

Do you have an additional Phone or Fax Number?*

YesNo

Additional Phone or Fax Number

Are you currently attending an ACC Church?*

YesNo

Which is your ACC Home Church?*

Name of your church (NSW/ACT)*

Please select

Name of your church (QLD/NT)*

Please select

Name of your church (SA)*

Please select

Name of your church (Tas)*

Please select

Name of your church (VIC)*

Please select

Name of your church (WA)*

Please select

Name of your church*

Name of Senior Pastor*

If yourself, please type NA

Church Location*

Suburb

State

Church Country*

Ministry Position*

Start Date*

DayMonthYear

Employment Capacity*

Please select

Have you attended an ACC State or Regional Meeting in 2020?*

YesNo

Date of attendance

DayMonthYear

Please confirm you are engaged in Active Ministry (as defined in the United Constitution)*

YesNo

Name of Itinerant Ministry

Ministry ABN

Please describe your regular functions/duties in this role

1) Working With Children Check/Clearance

With reference to your your 'working with children check/clearance' issued by your relevant State Government, please provide your check/clearance reference number in the space below, and attach a clear scan or photo of the check/clearance issued to you.

Reference Number*

Upload of Image

Upload a File

Maximum Size 1MB

If you are having problems uploading your the image of your check/clearance, you can email it to us at dues@acc.org.au. Please include your name and Pastor's ID in the email.

Expiry Date*

DayMonthYear

2) Child Protection Training (Safer Churches course or equivalent).

Have you completed a Child Protection Course in the last 3 years?*

YesNo

You will need to complete a Child Protection Course in order to receive your credential renewal. Please visit www.acc.org.au/SC_online to complete our course online.

Name of course*

Where completed?*

Date Completed*

DayMonthYear

Upload of Child Protection Course certificate of completion (if available)

Browse Files

By submitting this form I declare that the above information is true and correct and that there is no impediment to my credential being renewed. I have no financial debts or situations that could discredit the Movement. Apart from previous written disclosures to the Movement, I have not been charged or convicted for any illegal activity, nor have I been bankrupt or insolvent. I do not hold any doctrines or beliefs that are contrary to the doctrinal basis of the Australian Christian Churches. I am not involved in any behaviour unbecoming of a minister of the gospel, e.g. domestic violence, drunkenness, or sexual indiscretion.

I have read and agree to abide by the ACC doctrine, United Constitution including State By-laws and policies including the Ministerial Code of Conduct and Child Protection Policy. I agree to keep my State Government Legislative working with children check, and Safer Churches training (every 3 years) current throughout the term of my Credential renewal.

I give ACC permission to disclose information in relation to my credential to any church in which I minister or serve during the credential period, in order to verify my ministry status or other aspects of my service.

If you are unable to make the above declaration, please contact your Regional Leader / State Secretary to discuss.

PLEASE NOTE: The National Executive retains the right to remove your credential if any of the above information proves to be false or misleading in any way.

Name of person making this declaration*

First NameLast Name

Date of this declaration*

DayMonthYear

Would you like to update your photo on your Credential Card?*

YesNo

Please upload an updated colour photograph of yourself in a format similar to what you would provide for a passport application.

Photo upload

Upload a File

Some Pastors have indicated they have no use for a physical Credential Card - would you like to receive a Credential Card?
If you select 'No' below, other electronic proof of current Credential can be provided.

Credential Card?*

YesNo

Please confirm your Credential State and Term*

ACC Pastor's Dues

GST Included

Amounts include National & State Dues, Postage & Handling and GST (where applicable).

Payment Type*

My Products

AUDACC Pastor's Dues

Credit Card Details
First Name/s on Credit Card	Last Name on Credit Card
Credit Card Number	Security Code
Card Expiration

Cheque/Money Order
Please make payable to Australian Christian Churches, and note your Pastor's ID on the back of the cheque.

Bank Transfer
Bank: Commonwealth Bank of Australia
BSB: 063146
Account number: 10391792
Account name: Australian Christian Churches

Reference: Your Pastor's ID Code

No payment is required at this time.

ACCI Missions will invoice you direct.

Heading

2021 Credential Review Form

Personal Information

Ministry

Working With Children

Declaration

Dues