Volunteer Application Form : Get Involved : Catholic Charities of the Diocese of Palm Beach, Inc.

Dear Volunteer:

Thank you for offering your time and talent to work with the people in need within our diocese. Volunteers such as you are indispensible to our programs.

We truly appreciate your understanding of our need to make appropriate inquiries of those to whom the care of God's people is entrusted. Please supply the information requested below and submit this form to the Program/Ministry you want to volunteer with.

Contact Information

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First Name (Required)

Last Name (Required)

Email (Required)

Date of Birth (Required)

Work Phone

ext Extension

Home Phone

Driver's License No.

DO YOU HAVE ANY HISTORY OF PROBLEMS WITH THE LAW?

1. Have you ever been arrested?

2. Have you ever been accused of child neglect or abuse?

3. Has your driver's license ever been suspended or revoked?

4. Have you ever been on Probation?

Please explain if any answer above is "Yes":

Please provide as much detail as possible

REFERENCES: Please list names, addresses and phone numbers of those who are familiar with your character. Three (3) NON-FAMILY references please.

Name, Address, & Phone Number (Required)

Name, Address & Phone Number (Required)

Volunteer Opportunities

How did you hear about volunteer opportunities at Catholic Charities?

Please Choose a Program/Ministry you are Interested in:

Authorization & Declaration

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 Diocese of Palm Beach, its employees and agents, to make inquiries, including criminal history, employment history and driving history. I hereby release and agree to hold harmless from liability any person(s) or orgnanization, who, in good faith, provides information to complete a background investigation. I also agree to release and hold harmless the local parish, school, or other diocesan institution, the Diocese of Palm Beach, the Bishop of the Diocese of Palm Beach, 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 and national repositories of criminal records.

Under the penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true to the best of my knowledge and belief.

I also declare that I have read the Pastoral Code of Conduct and have been given a copy for reference. Bases on this code, I promise to embody all directives in my service to Catholic Charities;

I understand that any action inconsistent with the Pastoral Code of Conduct of failure to take action mandated by the Code of Conduct may result in my removal as a volunteer.

Volunteer's Printed Name (Required)

Signatures & Date left blank until office visit.

Volunteer Signature

Signature of Pastor/Administrator

Date

Preferred Response