I hereby authorize Chaplaincy Ministries, its designated agents and representatives, to conduct a comprehensive review of my background, causing a consumer report and/or invesitigative consumer report to be generated for membership purposes.

I understand this authorization automatically expires 90 days from the date executed below and that I have the right to revoke the authorization at any time provided I do so in writing.

Agreement
I acknowledge and affirm that the information provided by me in this renewal form, including all attachments and exhibits, is true and correct to the best of my knowledge. I hereby authorize Chaplaincy Ministries, or its designee, to conduct a complete investigation of my character and fitness to serve as a chaplain.

Chaplaincy Ministries was designed to certify chaplains primarily for United Pentecostal Church International (UPCI); however, we made provisions for other groups to join. Chaplains applying who are not UPCI members will receive the same endorsement without the UPCI note on their badge. They will not be able to purchase the police style shield as it has UPCI stamped on it.

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