Volunteer Application

Volunteer Application
Today's Date
Parish/School Name: blanks Location: blank
Name

Prefix First Name Middle Name Last Name Suffix
Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone
Home Phone
Work Phone Number
Work Phone Number
Cell Phone Number
Cell Phone Number
Email
example@example.com
Date of Birth (for background check)

Month Day Year
Volunteer position for which you are applying:

Employment Information
Are you currently employed?

Yes (If yes, please complete information below) No
Employer
Employer Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Describe Job Duties

Emergency Information
Name

First Name Last Name
Relationship
Home Phone Number
Home Phone Number
Cell Phone Number
Cell Phone Number
Work Phone Number
Work Phone Number
Please check if applicable:

You are a member of the clergy seeking service in the Archdiocese You are a deacon candidate You are a seminarian
Please indicate if you are: blanks A current employee or volunteer for this parish or school. blank What position?
Please specify your parish/school. If not a member of a parish, or associated with a school, please leave blank: blanks Parish/School. blank City
How long have you been associated with this parish/school?

Education
Name of High School
High School Graduate (check)

Yes No
Name of College
College Graduate: (check)

Yes No
Name of Graduate School
Graduate School Graduate (check)

Yes No
Specialized Education or Training (Please list)

Personal References
Reference One
Name
Relationship
Phone Number
Phone Number
Reference Two
Name
Relationship
Phone Number
Phone Number
Reference Three
Name
Relationship
Phone Number
Phone Number

Volunteer History
Volunteer history should include 5 of your most recent activities. If you are still participating in a volunteer program, then indicate “to” date as current.
Check here if you have no volunteer history.

Type option 1
Start with most recent dates
Volunteer History One
Start Date

Month Day Year
End Date

Month Day Year
Organization Name
Organization City, State

Street Address

Street Address Line 2

City State / Province
Contact Name
Contact Phone
Contact Phone
Position/Duties
Volunteer History Two
Start Date

Month Day Year
End Date

Month Day Year
Organization Name
Organization City, State

Street Address

Street Address Line 2

City State / Province
Contact Name
Contact Phone
Contact Phone
Position/Duties
Volunteer History Three
Start Date

Month Day Year
End Date

Month Day Year
Organization Name
Organization City, State

Street Address

Street Address Line 2

City State / Province
Contact Name
Contact Phone
Contact Phone
Position/Duties
Volunteer History Four
Start Date

Month Day Year
End Date

Month Day Year
Organization Name
Organization City, State

Street Address

Street Address Line 2

City State / Province
Contact Name
Contact Phone
Contact Phone
Position/Duties
Volunteer History Five
Start Date

Month Day Year
End Date

Month Day Year
Organization Name
Organization City, State

Street Address

Street Address Line 2

City State / Province
Contact Name
Contact Phone
Contact Phone
Position/Duties
Please explain your interest in volunteering
Is there a particular type of assignment or volunteer duty you would prefer?
Please list special skills, training and languages
Have you attended the Protecting God’s Children training?

Yes No
If Yes: When blanks Where blank
Please attach a copy of your Protecting God’s Children Certificate

Cancel of
Have you ever pled guilty to or been convicted of a crime? If yes, please give the date of the plea/conviction, the location (i.e. jurisdiction) and state the nature of the crime.
Are there any criminal charges currently pending against you? If yes, please explain.
Have your driving privileges been revoked in any state? If yes, please explain.

DECLARATIONS

We appreciate your willingness to share your faith, gifts and skills. Providing safe and secure programs for our members is of utmost importance to us. The information gathered in this application is designed to help us provide the highest quality Catholic programs for the people of our community.
Please read and mark the checkbox next to each of the statements below:
I declare that my volunteer application is complete, that all statements are true, and agree that false statements and/or omissions, including those regarding past conduct and/or present situations may be grounds for denial of my application to provide volunteer services or dismissal from my volunteer involvement.

Accept
I hereby authorize you to conduct a personal and professional reference check for the purposes of my application. You may, among other things, contact any references, church, youth organizations, agencies where volunteer service has been completed, and any individual or organization which might have information relevant to my desired position, including a consumer credit reporting agency (if my position entails handling money). I hereby release any person contacted from any and all liability for damages regarding statements given to you about me.

Accept
I also hereby give you permission to conduct a background check, including but not limited to, a criminal arrest records check, abuse registry check, and driving record check for the purposes of my volunteer services. I agree to cooperate as necessary with the background screening process. See separate Notice attached regarding Credit Reporting Agency check.

Accept
I understand and agree that information may be obtained from sources that I provided in the application and that this information need not be revealed to me.

Accept
I agree to observe all of the guidelines and policies relevant to the program for which I am applying, including, but not limited to, the Archdiocesan Policies on Professional and Ministerial Conduct and the Harassment and Sexual Harassment Policy.

Accept
I understand that you have a ZERO TOLERANCE for abuse of minors and vulnerable adults and take all allegations of abuse seriously. I further understand that you cooperate fully with the authorities to investigate all cases of alleged abuse. Abuse of minors or vulnerable adults is grounds for immediate dismissal and possible criminal charges.

Accept
I understand that I can withdraw from the application process at any time and that my acceptance as a volunteer gives me no rights to continued participation in any program as a volunteer or otherwise.

Accept
If at any time my volunteer activities involve driving my vehicle, I agree that I have applicable state motor vehicle insurance for my vehicle and that I am currently permitted to drive my vehicle under the laws of the State of New Jersey. I further agree to abide by all applicable state motor vehicle laws.

Accept
I authorize you to obtain such a report.

Accept
Confirmation
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Digital Signature*
Type Name
Date

Month Day Year
Should be Empty:

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Volunteer Application

Employment Information

Emergency Information

Education

Personal References

Reference One

Reference Two

Reference Three

Volunteer History

Volunteer History One

Volunteer History Two

Volunteer History Three

Volunteer History Four

Volunteer History Five

DECLARATIONS

Confirmation