Appendix Form 4
Diocese
of
Application for Volunteer Service
Parish Name: ____________________________________________________
Thank you for your interest in volunteering. The Catholic Church highly values and depends upon the gifts which each person offers to bring to service whether as clergy, religious, employee or volunteer. We are deeply appreciative of your willingness to offer to work within our community in service to others in the name of Christ Jesus. We thank you for offering to use your gifts with us in this unique and special way. Should you be assigned as a volunteer, we will strive to provide the ongoing support which you will need to carry out your work successfully. To assist in this effort, please complete this application and covenant agreement and discuss your interests with the designated staff member.
The following information is needed to better evaluate your skills, background, and interests.
I.
Personal
Data
Ms. Miss Mrs. Mr. Rev. Sr. Rev. Mr. Other _______________
Name:___________________________________ Date of Birth_________________
Address:_____________________________________________________________
Home Phone: __________________________ Work Phone: ___________________
Social Security Number: _____________________________
Driver License Number & State: _______________________ Expires: ___________
Specify any other name(s) you are or have been known by: _____________________
II.
Experience
Specify the job/areas of ministry for which you wish to volunteer: _______________ __________________________________________________________________________________________________________________________________________
Specify what days/hours you are available: __________________________________
Date available to begin: _____________________________
Please describe previous volunteer experience: _______________________________
________________________________________________________________________________________________________________________________________________
Please describe previous experience working with youth: ________________________ ________________________________________________________________________________________________________________________________________________
________________________________________________________________________Please describe educational background: ______________________________________
________________________________________________________________________
________________________________________________________________________
Please list specific training you have received: _________________________________
_______________________________________________________________________
______________________________________________________________________
Have you previously served as a volunteer/employee in the Catholic Church?yesno
Where: _____________________________________________ When: ______________
Have you ever had your services terminated? yes No
If yes, please explain:
______________________________________________________
________________________________________________________________________
Are you able to fully participate in the sacramental life of the church? yes no
Have you ever been accused of, charged with or convicted of any criminal violation?
yes no If yes, please
explain:
_________________________________________
________________________________________________________________________________________________________________________________________________
III.
Employment
Please list your employment history for the last five years. Include present employer and volunteer work, if any. If you are not employed, please indicate present status (i.e. student, retired ect.) and the beginning state of that status.
Present Employer:____________________________________Phone:____________
Employed from: _____________ to: _____________________Position: __________
Name of Supervisor: _________________________________ Phone: ____________
Previous Employer: __________________________________Phone: ____________
Employed from: ______________ to: ____________________ Position: __________
Name of Supervisor: _________________________________ Phone: ____________
Reason for leaving: ____________________________________________________
IV. References
List persons who have known you for at least 5 years (not immediate family or those already listed above).
Name: ________________________________________Phone: _________________
Address: _____________________________________________________________
Relationship: _________________________________________________________
Name: ________________________________________ Phone: ________________
Address: _____________________________________________________________
Relationship: _________________________________________________________
Name: ________________________________________ Phone: ________________
Address: _____________________________________________________________
Relationship: _________________________________________________________
As a volunteer, I do not expect compensation for services which I provide and/or offer. Further, the information which I have provided in this application is true and accurate to the best of my knowledge and belief. I understand that any false information made as part of this application will be sufficient cause for dismissal. I grant my permission to ________________________________________________
Catholic Church and the Diocese of
Birmingham in
I hereby authorize the release of the above requested information.
Signature of Applicant: ________________________________Date: ____________
As a volunteer, I will strive to serve to the best of my ability in accordance with the policies and regulations of the Catholic Parish of _____________________________
And the Diocese of
Signature of Applicant: ________________________________ Date: ____________