CONFIDENTIAL
ADULT VOLUNTEER APPLICATION
DIOCESE OF RENO
YOUR REFERENCES WILL BE CHECKED
Name:_______________________________________________________________________________________
First Middle Last
Mailing
Address:______________________________________________________________________________
Physical Address:(If
different)____________________________________________________________________
Home
Telephone:______________________________________________________________________________
Complete name of volunteer site:
(School/Parish)_____________________________________________________
City where volunteer site is
located:________________________________________________________________
Type of volunteer work to be
performed:____________________________________________________________
Name of supervisor at
site:_______________________________________________________________________
List other names you use or are known
by:__________________________________________________________
Employer/Business
Name:_______________________________________________________________________
Previous experience working with youth in organizations, schools, parishes:
(give years)_____________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
REFERENCES: Please list three references with name, address and telephone number
of individuals who are familiar with your character as it relates to working
with youth. Please be complete as references will be checked.
Name_______________________________________________________________Telephone#_______________
Address___________________________________________________Ref.
Checked_________Date___________
Name_______________________________________________________________Telephone#_______________
Address___________________________________________________Ref.
Checked_________Date___________
Name_______________________________________________________________Telephone#_______________
Address___________________________________________________Ref.
Checked_________Date___________
All volunteers who have regular contact with minors must complete this
application, attend a “Protecting God’s Children”™ Awareness Session, and
complete Virtus training.
If you have regular contact with minors you will also be required to submit
fingerprints.
I understand that:
The information I have provided may be verified, if necessary, by contacting
persons or organizations named in this application, or by contacting any person
or organization that may have information concerning me. I hereby release and
agree to hold harmless from liability any person or organization that provides
information. I also agree to hold harmless from liability in appropriately
utilizing this application information, parish, school, the Roman Catholic
Bishop of Reno and the officers, directors, employees and volunteers thereof. I
affirm the foregoing is true and correct to the best of my knowledge.
________________________________________________________________
__________________________
Signature of Applicant
Date
Reviewer’s notes: Authority at volunteer location is to review and sign
questionnaire.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
________________________________________________________________
__________________________
Signature of authority
Date