<p> DIOCESE OF PATERSON</p><p>VOLUNTEER APPLICATION</p><p>Name:_(Last)______(First)______(Middle)______</p><p>Address: ______Zip Code:______</p><p>Telephone - ______E-Mail Address: ______</p><p>Month/Day of Birth: ______</p><p>Previous Residence/Last 5 Years: ______Length of Residence ______</p><p>In case of emergency, notify :______</p><p>Education: ______Present and Former (Most recent first) Employer's name, address, telephone: ______</p><p>______</p><p>______</p><p>Positions held in the present and past: ______</p><p>______</p><p>______Interests, Skills, Hobbies:</p><p>______</p><p>______</p><p>______Car Available: Liability Insurance ______Driver's License # ______(Need copy of your license, please) Past Volunteer Experience: ______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>Describe Vol. Positions : ______</p><p>______</p><p>______</p><p>Do you have any prior experience working with people having disabilities? Describe. ______</p><p>______</p><p>______</p><p>What do you hope to accomplish in Volunteer Work? ______</p><p>______</p><p>______</p><p>______</p><p>Describe a significant experience in your life. ______</p><p>______</p><p>______</p><p>______</p><p>How much time can you volunteer? ______Weekend or evening?______</p><p>Good time of afternoon or evening? ______</p><p>How did you hear about "PEOPLE NEED FRIENDS"?______</p><p>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. </p><p>1.______</p><p>2.______</p><p>3.______</p><p>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?______</p><p>I understand that I need to schedule electronic fingerprinting for my criminal background check.</p><p>Signature of Volunteer: ______</p><p>Date : ______</p><p>Please check to see that all information requested has been completely filled in. </p><p>______For Department Personnel Only </p><p>Date of Interview : ______</p><p>Date of Orientation : ______</p><p>Program Assignment : ______</p><p>Starting Date : ______</p><p>Description of Assignment : ______</p><p>______</p><p>Signature of Director of Volunteers and Pastoral Care: ______Date : ______</p><p>Date of Termination : ______</p><p>Reason for Termination : ______1/6/98</p><p>3</p>