VOLUNTEER APPLICATION

ARCHDIOCESE OF MIAMI

Dear Volunteer:

Thank you for offering your time and talent to work with the youth of our parish/school. Volunteers such as yourself are indispensable to our programs. We truly dislike troubling you but we know you will understand that we face possible liabilities if we do not make appropriate inquiries of those to whom the care of our young people is committed. Please supply the information requested below and return this form to your Pastor/Parish Office (if you are a Youth Minister or assist in the youth ministry program) or to the Archdiocesan Catholic Committee on Scouting (if you are a religious counselor for Catholic Scouting program).

PLEASE PRINT

Name_________________________________________________________Social Security #____________________

Address__________________________________________City_____________________Zip Code_______________

Date of Birth________WorkPhone_________________Homephone____________________Cellphone____________

Driver's License No._______________________________________State__________

Parish______________________________________________________email_______________________________

MARITAL AND FAMILY STATUS

( )Single ( )Married ( )Widowed ( )Separated ( )Divorced

If married, please answer the questions below:

Name of Spouse_______________________________________________________

Were you married in the Roman Catholic Tradition? ( )Yes ( )No If yes, please give the parish ___________________

If no, please give the circumstances__________________________________________________________________

This is my ( )first ( )second marriage recognized by the Roman Catholic Tradition.

If divorced, has your first marriage been annulled by the Church? ( )Yes ( )No

Explain if necessary_______________________________________________________________________________

RELIGIOUS INFORMATION Parish

Baptism ( )Yes ( )No Parish_______________________________________

First Communion ( )Yes ( )No Parish________________________________

Confirmation ( )Yes ( )No Parish___________________________________

EDUCATION

Elementary Completed ( )Yes ( )No High School Completed ( )Yes ( )No

College ( )Yes ( )No Graduate Work ( )Yes ( )No

Specialization______________________________________________

DO YOU HAVE ANY HISTORY OF:

Alcohol or drug abuse ( )Yes ( )No

Mental Illness ( )Yes ( )No

Contagious Disease(s) ( )Yes ( )No

PROBLEMS WITH THE LAW

1. Have your ever been arrested? ( )Yes ( )No

2. Have you ever been accused of child neglect or abuse? ( )Yes ( )No

3. Has your driver's license ever been suspended or revoked? ( )Yes ( )No

Probation ( )Yes ( )No Please explain if any answer is "Yes":________________________________________

PRIOR EXPERIENCE WORKING WITH YOUTH: (Please check those that apply)

( ) Children (5-10) Explain__________________________________________________________________________

Name, address and phone number of your Supervisor:___________________________________________________

( ) Youth (11-14) Explain___________________________________________________________________________

Name, address and phone number of your Supervisor:___________________________________________________

( ) Teens (15-18) Explain___________________________________________________________________________

Name, address and phone number of your Supervisor:___________________________________________________

WHAT WOULD YOU SAY ARE YOUR STRONGEST GIFTS? ____________________________________________

PLEASE DESCRIBE IN YOUR OWN WORDS WHAT PROMPTED YOU TO VOLUNTEER YOUR SERVICES WITH THIS PROGRAM. ______________________________________________________________________________

REFERENCES Please list names, addresses, and phone numbers of those who are familiar with your character as it relates to work with youth.

Three (3) NON-FAMILY references please (excluding Pastor and Staff).

Name Address Phone

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

II. The information that I have provided may be verified, if necessary, by contacting persons or organizations named in this application, or by contacting any person or organization that may have information concerning me. I authorize the Archdiocese of Miami to make inquiries including criminal history and driving history. I hereby release and agree to hold harmless from liability any person or organization, who, in good faith, provides information to complete a background investigation. I also agree to release and hold harmless the local parish, the Archdiocese of Miami, and the officers, employees, and volunteers thereof from any present or future claim of any kind, resulting from any alleged liability for conducting a background investigation which may include, but not limited to, criminal courts, state and county repositories of criminal records.

III. In signing this application, I affirm that the information I have given is true and correct. Furthermore, I understand that volunteering is contingent upon a background screening including a criminal check.

Signature of Applicant __________________________________________________Date_____________________

Rvsd. 9/2003