Diocese of Paterson

DIOCESE OF PATERSON

VOLUNTEER APPLICATION

Name:_(Last)______(First)______(Middle)______

Address: ______Zip Code:______

Telephone - ______E-Mail Address: ______

Month/Day of Birth: ______

Previous Residence/Last 5 Years: ______Length of Residence ______

In case of emergency, notify :______

Education: ______Present and Former (Most recent first) Employer's name, address, telephone: ______

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Positions held in the present and past: ______

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______Interests, Skills, Hobbies:

______

______Car Available: Liability Insurance ______Driver's License # ______(Need copy of your license, please) Past Volunteer Experience: ______

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Describe Vol. Positions : ______

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Do you have any prior experience working with people having disabilities? Describe. ______

______

What do you hope to accomplish in Volunteer Work? ______

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Describe a significant experience in your life. ______

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How much time can you volunteer? ______Weekend or evening?______

Good time of afternoon or evening? ______

How did you hear about "PEOPLE NEED FRIENDS"?______

2 Please give the name and mailing address for three references (Persons not related to you): Include address, city, state, zip code, and e-mail address if possible, please.

1.______

2.______

3.______

Have you ever been convicted of forgery, embezzlement, obtaining money under false pretenses, extortion, criminal conspiracy to defraud, crimes against the person or other like offenses?______

I understand that I need to schedule electronic fingerprinting for my criminal background check.

Signature of Volunteer: ______

Date : ______

Please check to see that all information requested has been completely filled in.

______For Department Personnel Only

Date of Interview : ______

Date of Orientation : ______

Program Assignment : ______

Starting Date : ______

Description of Assignment : ______

______

Signature of Director of Volunteers and Pastoral Care: ______Date : ______

Date of Termination : ______

Reason for Termination : ______1/6/98