School 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 Name
Middle Name
Last 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 Code
Phone Number
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if different from above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Have you resided in any states other than NH during the past 5 years?
*
Yes
No
List all the states where you have resided during the past 5 years.
Position
Indicate the school 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?
*
Yes
No
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?
*
Yes
No
Please provide an explanation.
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 the principal within 14 days if I am arrested or convicted of a crime after signing this form.
Signature
*
First Name
Middle Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Please verify that you are human
*
Submit
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