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Volunteer Application Catholic Charities Fort Worth

Volunteer Application Catholic Charities Fort Worth

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Published by mpriceatccusa
Volunteer Application Catholic Charities Fort Worth
Volunteer Application Catholic Charities Fort Worth

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Published by: mpriceatccusa on Feb 21, 2013
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08/29/2013

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 Note: Applicants under 16 must have parent/guardian approval and parent/guardian must accompany applicant on allvolunteer activities with Catholic Charities Diocese of Fort Worth.
Personal Information
Today’s Date ____________ 
 
First MiddleLast
 
Address Apt #Home Telephone NumbeCityStateZIP codeCell Telephone Numbe
 
Email Address Language(s) other than English?
 
Volunteer Preference
I prefer to work with (check all that apply):Children* Homeless Health Services Donation Center Administrative/ClericalFamilies* Elderly Immigrants/Refugees Fundraising Financial Stability/VITA (site ____)
*NOTE:When asking to work directly with children and families, you may be subject to an additional criminal background check. This process can take up to THREE WEEKS. You will not be able to volunteer in these areas until the process is complete.
Volunteer Experience / Skills – Tell us about yourself.
 
For tracking purposes, please tell us how you heard about this volunteer opportunity:
Fort Worth Diocese, which Parish?
 
Other source Non-Diocese Church
Emergency Contact
 Name
 
Contact Info
 
Telephone Number or Email Address
FOR OFFICE USE ONLY
CBC Special Provision(s) TBInitials / Date
Personal References
Page 1 of 5
Catholic Charities
Diocese of Fort WorthSubject: Human Resource
COA: HR 3.03, HR 3.05, TS 3.05  Applies to: All Organization
Volunteer Application
Form: 1011-49Effective: June 27, 2007 Revised: June 21, 2011
 
Please provide two character references.
1.
 Name:
 
Telephone Number:
 
Email Address:
 
Years Known:
 
Relationship:
 
2.
 Name:
 
Telephone Number:
 
Email Address:
 
Years Known:
 
Relationship:
 
Current Employer
Company Name
 
Telephone Number 
 
Address
 
Supervisor’s Name
 
Length of Service
 
Criminal History
Have you ever been convicted of, received deferred adjudication, been given probation, received unadjudicated Yes No probation for, or pled no contest for any offense?Are you seeking Community Service hours to resolve a legal matter or as directed by the courts? Yes NoIf Yes, name of parole officer or court appointed contactContact # Nature of offense Number of hours needed Date to be completedHave you been convicted or have charges pending regarding child abuse or neglect, under civil and/or family law? Yes NoIf yes to any of the above, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently suchoffense(s) were committed, sentence(s) imposed, and type(s) of rehabilitation. Attach additional sheets, if necessary.
 
A criminal background check will be completed prior to volunteering. A prior offense is not necessarily a bar to volunteering. Failure todisclose a prior offense will prevent you from volunteering.
Confidentiality Agreement
I, , agree to protect the right to privacy of clients, staff members, and other volunteers who work,for or with Catholic Charities, Diocese of Fort Worth, Inc.I will discuss the following with my supervisor:
Any concerns or questions I may have about client care, program operations, and/or interactions with other volunteers or staff members.
Any situation that may be life threatening to volunteers, staff members, clients, or myself.
Any other information that I feel would impact the organization.During my volunteer time, I will limit my discussion about clients to that which is necessary to carry out my volunteer duties.I will not discuss or share information about clients or the services they receive with any one outside of Catholic Charities.I will not take photographs of clients, staff members, or other volunteers without the written consent from the individual or legalguardian, and the Program Coordinator or Department Director. I understand that children in the custody of the TexasDepartment of Family and Protective Services may not be photographed at any time.I have read and agree to abide by this agreement, and I understand that I can be released as a volunteer from Catholic Charities,Diocese of Fort Worth, Inc. should I violate any of these conditions.
Please read before signing.
I authorize persons and current employers or organizations referred to in this application to answer questions Catholic Charitiesmay have regarding my association with them.I hereby declare that the information provided by me in this application is true, correct and complete to the best of my knowledge.I understand that if volunteering, any misstatement or omission of facts on this application shall be cause for dismissal.I hereby acknowledge that I have read the above statement and understand the same.SignatureDate
This Volunteer Application is considered incomplete without the Authorization for Release of Information form.
 
Page 2 of 5
 
 
 NAME (Last, First, MI)OTHER NAMES USED (Including Maiden Names)
 
DRIVERS LICENSE #STATEEXP DATE
 
DATE OF BIRTHSOCIAL SECURITY NUMBE
Provide home addresses for the past seven years, most recent firstStreet, Apt #CityCountyStateZIP
 
I understand that my employment and/or unpaid service with Catholic Charities is conditional, pending the satisfactory completionof one, several or all of the following:
Criminal Background InvestigationEducational/Licensing/Certification VerificationDriving Records Check TB TestDrug TestCredit Report
 
(Required only when job/volunteer duties necessitate such a report)
I understand that an investigative consumer report may be requested that could include information as to my character, work habits, performance and experience, along with reasons for termination to employment from previous employers. Further, Iunderstand that you may be requesting information concerning criminal history from various public and private sources, credithistory from one or more credit reporting agencies and, for some positions, a driving record.I hereby authorize all previous employers, law enforcement agencies, administrators, state agencies, institutions, informationservices, service bureaus, credit bureaus, and other public or private entities which may possess the above mentioned informationto furnish such information to Catholic Charities, Diocese of Fort Worth, Inc. as needed.I acknowledge my understanding that within five days after I request it in writing, I am entitled to complete, accurate disclosure of the nature and scope of such an inquiry.I further acknowledge that a telephone facsimile (FAX) or photocopy of this release authorization shall be as valid as the original.According to the Fair Credit Reporting Act, I am entitled, upon request, to receive additional information concerning the natureand scope of any information requested. I am also entitled to a copy of the consumer report obtained if information from the reportwill be used in making an adverse decision concerning my employment.I hereby release Catholic Charities, Diocese of Fort Worth, Inc., it agents, and all persons, agencies, and entities providinginformation or reports about me, from any and all liability arising of the request for or release of any of the above mentionedinformation or reports.I further acknowledge receipt of the notice required by federal law: “A Summary of Your Rights Under the Fair Credit ReportingAct” (attached hereto as Exhibit A).I understand that this release is valid from the date it is signed until it is revoked in writing or until my last day of employment (or unpaid service) with Catholic Charities.
 
SignatureDate
Page 3 of 5
Catholic Charities
Diocese of Ft. WorthSubject: Human Resource
COA:HR 3.03, HR 7.01 Applies to: All Organization
Authorization for Release of Information
 
Form: 1011-6 Effective: June 27, 2007 Revised:
 
May 27, 2009

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