Volunteer Application (Page 3 of 3) in pdf

If yes, please explain. Please include in your explanation the offense alleged and the disposition

of the matter, including: the date and jurisdiction of any conviction; guilty plea; nolo contendere

plea (no contest); finding of guilt following a trial; or, the receipt of probation before judgment.

_____________________________________________________________________________________

IMPORTANT – The following must be read and signed by

all applicants.

I hereby confirm that the information provided in this application is true, correct, and complete. If

accepted as a volunteer, any misstatement or omission of fact on this application may result in my

dismissal. I hereby authorize the Archdiocese of Washington to conduct, obtain, and review state and

federal criminal background checks based on the personal identification information I have provided

herein. I hereby grant the Archdiocese of Washington permission to check my background and references

as set forth above. Except in the case of its negligent misuse of the information obtained, I hereby release

the Archdiocese of Washington, its officers, directors, agents, employees, or representatives from any and

all claims arising from or in connection with my background screening.

I understand and acknowledge the Roman Catholic religious nature of the Archdiocese of Washington. I

understand and acknowledge that, in accordance with their role as Church volunteers and in witness to

the Gospel of Jesus Christ, archdiocesan volunteers must conduct themselves with integrity and act in a

manner consistent with the official teachings, doctrines, laws, and policies of the Roman Catholic Church.

Signature:_______________________________________________ Date:_______________________________

This section is to be completed by Pastor, Principal or Agency Director only.

The necessity of passing a state and federal criminal background check for positions involving substantial contact with minors or other

vulnerable persons while providing volunteer services has been explained to this applicant. Acceptance of volunteer services is

contingent upon the applicant successfully completing the state & federal criminal background check. Signed applications are to be

returned to the Child Protection Coordinator at your parish, school or agency for forwarding to the Archdiocese Office of Employee &

Volunteer Services.

__________________________________

___________________________________________ _______________

Authorized Signature

Date

Name of Parish, School, Agency

Location Number

Telephone number

)

Volunteer Application Page 3