Volunteer Form
  • Personal Information
    • First Name:*
       
    • Middle Name:
       
    • Last Name:*
       
    • Home Address 1:*
       
    • Home Address 2:
       
    • City:*
       
    • State:*
       
    • Zip*
       
    • Home Phone:*
       
    • Work Phone:
       
    • Cell Phone:
       
    • Email:*
       
    • Date of Birth:*
       (MM/DD/YYYY)  
    • Last 4 of SSN:*
       
    • Driver's License Number*
       
    • Driver's License State*
       
    •  
  • Program Interest
    (Please select all programs you are interested in serving)
    • Emregency Aid
      Yes
      No
    • Representative Payee
      Yes
      No
    • Immigration/Refugee Services
      Yes
      No
    • Office for Persons with Disability
      Yes
      No
    • Family & Individual Counseling
      Yes
      No
    • Housing Counseling/ Family Self-Sufficiency
      Yes
      No
    • First Call
      Yes
      No
    • Healthy Living Center
      Yes
      No
    • Mother Teresa Shelter, Inc.
      Yes
      No
    • Reception
      Yes
      No
    • Do you have any limitations that would impair your ability to perform as a volunteer? *
      (If yes, please explain below)
      Yes
      No
    • If yes, please explain:
    •  
  • Employment Information
    • Are you currently employed?*
      (If yes, please complete information below)
      Yes
      No
    • Employer:
       
    • Address 1:
       
    • Address 2:
       
    • City:
       
    • State:
       
    • Zip
       
    • Describe job duties:
    •  
  • Volunteer Experience
    • Preference of duties:
      (please explain)
    • Languages spoken
      (other than English)
    • Languages written
      (other than English)
    • Are interested in serving as a Sign Language Interpreter?*
      Yes
      No
    • Are interested in serving as a Braille Interpreter?*
      Yes
      No
    • Have you ever been convicted of a crime?*
      (If yes, please explain below)
      Yes
      No
    • Explanation:
    •  
  • Previous Volunteer Experience 1
    • Name of Volunteer Program
       
    • Date
       (MM/DD/YYYY)  
    • Types of Duties Performed
    •  
  • Previous Volunteer Experience 2
    • Name of Volunteer Program
       
    • Date
       (MM/DD/YYYY)  
    • Types of Duties Performed
    •  
  • Previous Volunteer Experience 3
    • Name of Volunteer Program
       
    • Date
       (MM/DD/YYYY)  
    • Types of Duties Performed
    •  
  • Education
    • High School Diploma*
      Yes
      No
    • Year:
       
    • List any other training, certifications, or porfessional licenses completed:*
    •  
  • Volunteer Shifts
    Please list the day of the week you are available to volunteer
    • 8:00 am - 10:00 am
        Write M, T, W, TH, F
    • 10:00 am - 12:00 pm
        Write M, T, W, TH, F
    • 12:00 pm - 2:00 pm
        Write M, T, W, TH, F
    • 2:00 pm - 4:00 pm
        Write M, T, W, TH, F
    •  
  • Emergency Contact Information
    • Name:*
       
    • Relationship:*
       
    • Home Phone:*
       
    • Work Phone:
       
    •  
  • Reference 1
    (All candidates will be required to undergo drug and criminal history screening)
    • Phone:*
       
    • Name:*
       
    • Relationship:*
       
    •  
  • Reference 2
    • Phone:*
       
    • Name:*
       
    • Relationship:*
       
    •  
  • Reference 3
    • Phone:*
       
    • Name:*
       
    • Relationship:*
       
    •  
  • To be completed by all:
    • Have you ever committed, been accused of or been convicted of child abuse, neglect or crimes against the elderly or disabled?*
      Yes
      No
    • Have you ever been subject to any court order involving an allegation of sexual, physical or verbal abuse of a minor?*
      Yes
      No
    • If yes, please provide offense, date of offense or conviction and location of court:*
       
    • As of the date of this consent form, do you have any pending charges against you?*
      Yes
      No
    • If Yes, please provide offense, date of offense or conviction and location of court:*
       
    • Has your driver's license ever been revoked or suspended?*
      Yes
      No
    • If Yes, please provide offense, date of offense or conviction and location of court:*
       
    • Other than the previous information provided, is there any other fact or circumstance, involving you or your background that would call into question your being entrusted with the supervision, guidance and care of young people? If Yes, please explain:*
       
    • If you answered Yes to either of these questions, please explain here:*
       
    •  
  • APPLICANT’S STATEMENT AND AUTHORIZATION TO RELEASE
    I certify that all of the above information is correct and true to the best of my knowledge. I further understand that false or misleading information may be grounds for rejection of my application. I hereby give Catholic Charities of Corpus Christi, Inc. permission to conduct a background check as well as contact any of my references.
    • I hereby acknowledge that I have read and understand the above statements.*

    •  
  • Security Code*

    (Enter the code above)
  •  
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