Parish Volunteer Application

Parish Volunteer Application

Volunteers who regularly work with minors must undergo background screening and training in addition to completing this volunteer application form.
Identifying Information
Name*

First NameMiddle NameLast Name
List any other names you have been known by, including maiden and nicknames
Date of Birth (Date of birth is requested for identification purposes only.)*
mm/dd/yyyy
Phone Number*

Area CodePhone Number
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you resided in any states other than NH during the past 5 years?*

YesNo
List all the states where you have resided during the past 5 years.
Position
Indicate the parish in which you wish to volunteer (include the city or town):*
Indicate the position you are seeking:*
Have you ever committed, been arrested or been convicted of physical or sexual abuse or neglect of a minor (person under age 18) or a vulnerable adult (person who is 18 or older and who is particularly susceptible to manipulation because of a mental or physical disability) that has not been annulled by a court?*

YesNo
Please provide an explanation.
Have you ever been subject to any court order involving an allegation of sexual, physical, or verbal abuse of a minor or a vulnerable adult?*

YesNo
Please provide an explanation.
Are you applying to be a Scout volunteer?*

YesNo
Please indicate the parish (include town) in which you are registered.
Have you been registered for six months or more?

YesNo
You must provide a written recommendation from a pastor or a parish supervisor from your previous parish in order to work with minors.
Acknowledgment*

By signing this form, I certify that the information contained herein is true to the best of my knowledge and belief. I authorize the Roman Catholic Diocese of Manchester to investigate the information contained on this form, including my criminal conviction record. I understand that it is my obligation to notify my pastor within 14 days if I am arrested or convicted of a crime after signing this form.
Signature*

First NameMiddle NameLast Name
Date*

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

Parish Volunteer Application

Identifying Information

Position