BOARD OF ORDAINED MINISTRY CALIFORNIA-PACIFIC ANNUAL CONFERENCE THE UNITED METHODIST CHURCH DECLARATION REGARDING SEXUAL MISCONDUCT (DISCIPLINARY REQUIREMENT ¶324.12)
DEADLINE: DECEMBER 1UNTIL 11:59:59 P.M. (PST)
(OF THE YEAR PRIOR TO THE COMMISSIONING YEAR) PLEASE TYPE, PRINT, SIGN, SCAN, AND SUBMIT A SINGLE PDF OF THE ENTIRE FORM (PAGES 19 & 20) VIA EMAIL TO BOTH:
Ms. Cathy Wilson -
[email protected] Rev. Sunyoung Lee –
[email protected]
Instructions Please read and complete the following declaration and return the notarized copy to the appropriate registrar of the conference Board of Ordained Ministry. “Each candidate shall submit on a form provided by the board of ordained ministry a notarized statement detailing any written accusations or convictions for felony, misdemeanor, or incident of sexual misconduct, or certifying that this candidate has neither been accused in writing nor convicted of a felony, misdemeanor, or any incident of sexual misconduct.” ¶ 324.12, The Book of Discipline, 2012 edition. In light of the above paragraph, please respond to the following inquiries. Initially, please write out the word “Yes” or the word “No” in the space provided following each of the questions and then proceed. Candidate declares and says the following: (Print Name) 1. Have you ever been accused in writing of any sexual misconduct?
Answer:
[If more than one accusation has been made, please photocopy this form and include completed copies as part of this Declaration.] If you have answered “Yes”, please describe the accusation including: a. Date of Incident: b. Details of Incident:
c. Name of Accuser: d. File Location of Written Accusation: e. Resolution of Accusation:
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Name: 2. Have you ever been convicted of a felony, misdemeanor, or incident of sexual misconduct? Answer: If you have answered “Yes”, please describe the conviction, including: [If more than one conviction has been rendered against you, please photocopy this sheet as needed, and, after completing additional sheets, include them in this declaration.] a. Statute or Policy Cited: b. Name of Court & Address: c. Case Name & Number: d. Date of Conviction: e. Brief Details of Allegation:
f. Penalty Imposed by the Court or Other Authorized Person:
I declare under penalty of perjury under the laws of the state of California that the foregoing is true and correct. Signed:
Date: (To Be Completed by the Notary) Insert an extra page if necessary
State of (
)
County of Subscribed and sworn to (or affirmed) before me on this Day of
, 20
, by
proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.
(Seal)
Signature Declaration Regarding Sexual Misconduct/June 2016
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