Volunteer Application in the Archdiocese of Miami
Dear Volunteer:
Thanks you for offering your time and talent to work with the youth of Mother of
Christ Catholic School. Volunteers such as you are indispensable to our
programs. We truly dislike troubling you but we know you will understand that we
face possible liabilities if you do not make appropriate injuries of those to
whom the care of our young people is committed. Please supply the information
requested below and return this form to your Principal or the school office.
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Personal Information (please print):
Name_____________________________
Social Security#: _______________________
Address ____________________________________
Date of Birth: ________________________________
Work #____________ Home # ____________ Cell #_______________
Driver’s License No: _________ ________ State: ________________
Catholic Parish or other church membership: ___________________________________
Your Child/ren’s full name: _________________________________________________
Problems with the law:
[ ] yes [ ] no Have you ever been arrested?
[ ] yes [ ] no Have you ever been accused of child neglect or abuse?
[ ] yes [ ] no Has your driver’s license ever been suspended or revoked?
[ ] yes [ ] no Are you currently on probation with the law?
[ ] yes [ ] no Have you any history of alcohol or drug abuse?
[ ] yes [ ] no Do you have any history of contagious disease?
[ ] yes [ ] no Do you have any history of mental illness? |
If you answered ‘yes’ to any of these last questions,
please explain:_________________________________
______________________________________________
Reference: Please list names, addresses, and phone numbers of those who are familiar with your character as it relates to work with youth. These (3) non-family references, please (excluding the pastor and staff.) |
1. Name:___________________________
Phone: __________________________
Address: _________________________
2. Name: ___________________________
Phone: __________________________
Address: _________________________
3. Name: ___________________________
Phone: __________________________
Address: _________________________
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A. 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 hereby release and agree to hold harmless form liability any person or organization that provides information. I also hold harmless the school, parish, the Archdiocese of Miami, and the officers, employees, and volunteers thereof.
B. In signing this application, I affirm that the information I have given is true and correct. Furthermore, I understand that volunteering in contingent upon a background screening.
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Signature of Applicant: ___________________________________
Signature of Principal: ___________________________________
Date:___________________ |