Your Information

Date of Application

Other Names Used

Date of Birth

Your Email (required)

Home Address (required)

City (required)

State (required)

Zip (required)

How Long at Current Address (required)

Please List Your Other Addresses, if any, in the last seven (7) years:

Home Telephone

Other Phone at which we may contact you

Emergency Contact

First Name

Last Name

Relationship

Telephone

Have you lived in another state within the past 10 years?
If you checked 'yes' you must have a FBI Background Check.
YesNo

What inspired you to volunteer with STVCC?

How did you hear about STVCC?

Where did you find the contact information for STVCC?

Relevant Experience (Please describe prior volunteer experience; experience with persons with characteristics similar to those served by STVCC; education and work experience)

List any other skills or experiences that might be useful in your volunteer placement: (computer skills, language, conferences, training, etc.)

References: (Please identify 3 non-relative references)

First Name Reference 1

Last Name Reference 1

Email Reference 1

Telephone Reference 1

How long have you known Reference 1?

Nature of Relationship: How do you know Reference 1?

First Name Reference 2

Last Name Reference 2

Email Reference 2

Telephone Reference 2

How long have you known Reference 2?

Nature of Relationship: How do you know Reference 2?

First Name Reference 3

Last Name Reference 3

Email Reference 3

Telephone Reference 3

How long have you known Reference 3?

Nature of Relationship: How do you know Reference 3?

Have you ever been convicted of a felony?
If yes, please explain the circumstances:
YesNo

Availability

What Are the Days of the Week That You Are Available?
SundayMondayTuesdayWednesdayThursdayFridaySaturday

Please specify the times of the day that you are able to volunteer

Interests, Preferences, Skills

To help us match you with an appropriate volunteer experience please check all the areas that would be of interest to you. Volunteer Descriptions can be found at stvcc.org/volunteering-opportunities.

Administration
Office/ClericalAgency EventAgency ResearchFaith Community LiaisonParish LiaisonAmbassador3rd Party (Fundraising)

Child Welfare
Office/ClericalMentorParenting Time AssistantTransporterWendy's Wonderful Kids Program

Children's Home
RecreationalTutorMentor

Counseling
Seasons: Supporting Families Through Serious Illness Assistant

Facilities
General Facilities

Holiday Help
Holiday Help

Immigration Law Clinic
Interpreter (Burmese, Hattian Creole, Farsi, Kareeni, Kinyarwanda, Nepali, Somali, Spanish, Swahili)Marketing & Communications

Refugee Services
Family Mentor

Describe other preferences or interests:

Why do you want to volunteer?

Are there any situations or circumstances in which you are not comfortable?

Which program are you MOST interested in volunteering with?

In order for us to be able to process your application, please review and initial each of the statements below:

I declare that all statements contained in this application are true and that any misrepresentation or omission may result in rejection of my application and/or termination of my relationship with St. Vincent Catholic Charities at any time.

Volunteers who have been treated for other than minor illnesses may be asked to submit a statement from their physician that they are able to properly carry out their duties. Volunteers must provide their own medical insurance. The Diocesan Protected Loss Fund Program self funds an amount up to $5000 for medical expenses not covered by the volunteer's own medical insurance.

I authorize you to conduct a criminal background check, as well as personal and professional background checks, for the purposes of consideration of this application. You may contact any references, past and current employers, and any other individual or organization that might be relevant to the position for which I am applying - except for those specifically excluded in writing on this application. I hereby release all of these references, employers and other individuals/organizations from any and all liability for damages that might occur in connection with the processing of this application.

This organization prohibits and does not tolerate discrimination in any form, including harassment, that is based upon a persons protected status, such as sex, color, race, ancestry, religion, national origin, age, disability, medical condition, marital status, veteran status (including past, present or future application for, or membership in, a uniformed service), citizenship status, or other protected group status. This organization is an equal opportunity employer that makes, supports, and subscribes to a policy of nondiscrimination in all aspects of employment. The agency's practices are based on job qualifications without regard to race, color, religion, national origin, sex, age, height, weight, marital status, veteran status (including past, present or future commitments to the uniformed services), handicap or any other reason prohibited by applicable laws.

My submissiom indicates that I have read all of the above statements, that I asked any questions I may have had, and that I fully understand all of these statements.