Forms to Go to Safe Environment Coordinator

Volunteer Packet

As you welcome and train new volunteers into your program here are some important forms and reminders to help you on the way.

Forms to go to Safe Environment Coordinator: (Keep Copies for Youth Ministry Files as Well)  Uniform Volunteer Questionnaire

 Code of Conduct

*Remember that ALL adult volunteers who will be regularly working with young people under the age of 18 must attend a Protecting Gods Children workshop. Please refer them to the Virtus.org website for a list of upcoming training opportunities. See your parish Safe Environment Coordinator for more information or contact the Diocese of Buffalo Safe Environment Office at (716) 847-5532 or e-mail: [email protected].  Reference Check Script ~ Please keep all notes taken during a reference check on file with parish Safe Environment Coordinator

Forms to Keep in Your Youth Ministry File  Drivers Information Sheet ~ to be filled out by all those driving on field trips (Drivers must be 21 or over)

*Mail original to Diocese of Buffalo Insurance Services a minimum of 2 weeks prior to trip if traveling a substantial distance  Volunteer Interest Survey ~ The form provided is an example of a helpful tool that can serve as a guideline when interviewing and training volunteers. Keep it on file and review it periodically as you see fit.

UN I F O R M VOLUNTEER Q U E S T I O N NA I R E We do not discriminate in our selection of volunteers on the basis of race, color, age, sex or national origin. We may consider the candidate’s religious affiliation in its decision to accept you as a volunteer because of its status as a religious entity, consistent with state and federal law.

Last Name: First: Middle Init:

Preferred Name: Parish or Institution:

Social Security Number: - - Date of Birth: / / (Month) (Day) (Year) Address: (Street Address) (Apt) (City) (State) (ZIP code)

Telephone # (Home): (Business):

Nature of volunteer assignment:

Date volunteer assignment will begin or began:

E MPLO YME NT RE C O RD CURRENT OR MOST RECENT EMPLOYMENT: Employed by:

Address: (Street Address) (City) (State) (ZIP code)

Your Supervisor: Telephone #

Supervisor’s title:

Employed from: to (month/year) (month/year)

Why did you leave?

IF EMPLOYED LESS THAN TWO (2) YEARS, PREVIOUS EMPLOYMENT:

Employed by:

Address: (Street Address) (City) (State) (ZIP code)

Your Supervisor: Telephone #

Supervisor’s title:

Employed from: to (month/year) (month/year)

Why did you leave? Office Use: References Checked Yes No

V O LUNTEE R S ERV I C E O R P ER S O NA L RE F E R ENCE S W I T HI N T H E P A ST T H RE E ( 3) Y E A R S : or list other references

Organization Name / Address / Supervisor Position Dates Tele.#

Religious affiliation:

Have you ever been discharged or asked to resign by your employer or a volunteer organization?

I Yes I No If yes, please state circumstances:

Have you ever been convicted of, or are you currently under indictment for a crime with the exception of a traffic offense? I Yes I No Date: Please explain.

State charge and disposition:

Are you now or have you ever been the subject of an indicated report of child abuse, neglect or mal- treatment? I Yes I No Date: If yes, please explain.

Your answer is looked upon only as one of the factors considered in our decision and is evaluated in terms of nature, severity and date of the offense. No applicant will be excluded from consideration due to prior arrests.

APPL ICA NT ’S AG REE ME NT : I hereby represent that each answer to a question herein and all other information or personal references furnished is true and correct. I further represent that such answers and information constitute a full and complete disclosure of my knowledge with respect to the question or subject which the answer or information relates. I understand that any incorrect or false statements or information furnished by me will subject me to discharge at any time. I hereby authorize my former employers and organizations to which I volunteered my services or personal references to give any information regarding my employment or volunteer services with them and, in addition, to furnish any other information they may have concerning me including, but not limited to, character, general reputation and personal characteristics.

I also understand I am subject to a thorough background check including criminal history.

I understand that my volunteer services are for no definite period and may be terminated at any time without previous notice.

Signature of Applicant ______Date ______Diocese of Buffalo Code of Co n d u ct For Priests, Deacons, Pastoral Ministers, Administrators, Staff, and Volunteers Code of Condu c t

Adults who work with children or young adults through the Diocese of Buffalo or any of its parishes or schools have the legal, moral, and religious responsibility to perform their duties in a way that educates and assists – and does not harm -- the children and young adults with whom they work. In keeping with that obligation, the Diocese of Buffalo establishes the following Code of Conduct for all who minister to children and young adults in the parishes of the Diocese, teach children and young adults in the schools of the Diocese, coach children and young adults on sports teams connected with the Diocese or any of its parishes or schools, or in any other way work with children and young adults through the Diocese of Buffalo.

As one of the priests and religious, teachers and coaches, employees and /or volunteers, who work with children and young adults in or through the Diocese of Buffalo, I solemnly pledge that:

1) I will to the best of my ability, perform my work in a manner consistent with the mission of the Catholic Church and the Diocese of Buffalo;

2) I will always remember that I am not a peer of the children or young adults with whom I work and I will perform my duties accordingly;

3) I will maintain appropriate physical and emotional boundaries from the children and young adults with whom I work;

4) I will avoid situations where I am alone with a child and/or young adult at Church activities;

5) I will refrain from any and all physical conduct, conversations and other communications with children or young adults that have a sexual purpose or result;

6) I will not touch a child and/or young adult in a sexual or other inappropriate manner;

7) I will report suspected abuse to the pastor, administrator, or appropriate supervisor and I will report to the appropriate office of the District Attorney any allegation of sexual abuse of a person who is a minor;

8) I will cooperate fully in any investigation of abuse of children and/or young adults;

9) I will treat everyone with respect, loyalty, patience, integrity, courtesy, dignity, and consideration;

10) I will use positive reinforcement rather than criticism, competition, or comparison when working with children and/or young adults;

11) I will neither accept expensive gifts from children and/or young adults nor give expensive gifts to them without prior written approval from the parents or guardians and from the pastor or administrator;

12) I will not smoke or use tobacco products in the presence of children and/or young adults;

13) I will not use, possess, or be under the influence of alcohol while working with children and/or young adults;

14) I will not use, possess, or be under the influence of illegal drugs at any time;

15) I will not pose any health risk to children and/or young adults (i.e., no fevers or other contagious situations);

16) I will not strike, spank, shake, or slap children and/or young adults;

17) I will not humiliate, ridicule, threaten, or degrade children and/or young adults;

18) I will not use any discipline that frightens or humiliates children and/or young adults;

19) I will not use profanity in the presence of children and/or young adults. I understand that this code is to be applied fairly and equitably on a case by case basis. Pg 1/2 I understand that whenever I am working with children and/or youth, as a volunteer or employee, I am subject to a thorough background check including criminal history. I further understand that this criminal background check will be conducted prior to beginning my employment/assignment and thereafter at such times and frequencies as determined by the agency, department, and/or organization by which I am employed and/or to which I am assigned. I understand that criminal background and character reference information may be requested from public and private sources. I understand that any action inconsistent with this Code of Conduct, or actions inconsistent with Diocesan policies for the protection of children and young adults, or failure to take action mandated by this Code of Conduct may result in removal from my position. I also understand that this code of conduct does not abrogate or replace any other obligations that I have under any applicable law, guideline, policy or regulation. I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, or reference contacted by the Diocese of Buffalo or its agent to furnish the information described herein. I hereby release the employer and agents and all persons, agencies, and entities providing information or reports about me from any liability arising out of the requests for or release of any of the information or reports herein.

Printed Name

Signature Date

Rev. March 26, 2015

Pg 2/2 Reference Checking Guidelines Pg. 1/2

When calling references, be sure to allow plenty of time for discussion. If necessary, call back. Take good notes and use the reference’s own words.

When recording remarks: 1. Identify yourself immediately by title and company name and tell the person that the candidate has given that person as a reference with permission to call. 2. Verify dates and actual duties that the person performed while working there. How did the candidate compare to other work effort. 3. See how the department was organized and the structure of the organization and how the position fits into the organization. How long has the person known the candidate? 4. Tell the person the position you are attempting to fill. 5. Tell them the principal duties and responsibilities.

For use in documenting this reference checking session:

Interviewer’s Name: Date of Reference Check:

Name of Applicant: Reference Type: Ph o n e / I n Pe r s o n / O t he r

Name of Person Used as a Reference:

Some suggested questions to ask:

1. Does the reference feel the person would do well in this position?

2. What areas does the reference feel the person may be strong?

3. What areas does the reference feel the person may need some training?

4. What areas does the reference feel the person may be weak?

5. What does the reference feel are the persons (5) major strengths?

6. What does the reference feel could be a possible weakness in the candidate?

Safe Environment Office – Catholic Center – 795 Main Street, 3rd Floor – Buffalo, NY 14203 Phone: (716) 847-5532 – FAX: (716) 847-5538 – e-mail: S a f e K ids @ b u ff a l od i oc e se . o rg Pg 2/2

7. How closely was he/she supervised in his/her job?

8. Did he/she supervise others? How many people reported to him/her? How would you rate him/her as a supervisor?

9. How did he/she get along with his/her supervisor?

10. Was he/she difficult to motivate?

11. Did family trouble, financial worries, drinking, drugs, or other personal problems interfere with his/her work?

12. What kind of job would you think is best suited to his/her abilities?

13. Would the reference recommend the candidate for the position?

14. Would the reference have any concerns about the applicant working alone with or around children?

At the conclusion of the reference check, thank the person and again give him/her your name, parish and telephone number and tell them if you can ever help them in any way to let you know.

Rev. 08/08/2007 Reference Checking Page 2 of 2 DIOCESE OF BUFFALO DRIVER INFORMATION SHEET

Driver Name ______Date of Birth _____/______/______Address ______Home Phone # ______Cell Phone # ______Driver’s License # ______Date of Expiration ______

Vehicle That Will Be Used Name of Owner ______Model of Vehicle ______Address of Owner ______Make of Vehicle ______Year of Vehicle ______License Plate # ______Date of Expiration ______

If more than one vehicle is to be used, the aforementioned information must be provided for each Vehicle.

Insurance Information When using a privately – owned vehicle, the insurance coverage is the limit of the insurance policy covering that specific vehicle. Insurance Company ______Policy # ______Date of Policy Expiration ______Liability Limits of Policy* ______

 Please note: the minimal, acceptable liability limit for privately-owned vehicles is $100,000 per person/ $300,000 per accident for bodily injury and $100,000 per accident property damage (or $300,000 combined single limit).

Certification I certify that the information given on this form is true and correct to the best of my knowledge. I understand that as a volunteer driver, I must be 21 years of age or older, possess a valid driver’s license, have the proper and current license and vehicle registration, and have the required insurance coverage in effect on any vehicle used to transport students.

______Signature Date Volunteer Interest Survey

Name ______Date ______

Address ______

Cell (______)______Home (______)______

Email ______

Birthdate: (month/ day) ______I am over 18 Y N I am over 21 Y N

Preferred Method of Communication for reminders etc. :

Call: Cell ___ Home___ Text__ Email __ Mail ___

I am willing to be Virtus Certified Y N

I am willing to meet periodically with the Youth Ministry Leader Y N

I am willing to receive training and enrichment: (Mark all that apply)

Attend Workshops___ Read___ Webinars___ Meet with YML___ Retreats__

I am available: (Circle all that apply) Mornings Afternoon Evenings

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

1xWK 2xWK 3xWK 1x Month 2x Month Occasionally I don’t know

I enjoy working with teens: Y N I prefer to work behind the scenes: Y N

I am comfortable sharing my Faith Y N

I have a talent I would like to share: ______

I want to volunteer because ______