St Vincent de Paul Food Pantry

Volunteer Application

PLEASE COMPLETE THE APPLICATION IN FULL AND PRINT ALL REQUIRED INFORMATION LEGIBLY

-- THANK YOU! INFORMATION ON THIS FORM WILL BE TREATED AS STRICTLY CONFIDENTIAL.

Personal Information

______

Last Name First Middle

______

Address Number /Street City State Zip

Preferred Phone Number: ( ) ______- ______E-mail: ______

In an emergency

Notify ______Relationship ______

Telephone ______

Are You 18 Years or Older? Yes_____ No______

What volunteer position are you applying for? ___ Serve Guests ____Help with Delivery ___Produce Pick-up

Have you ever been convicted of a crime? Yes____ No____ If yes, provide details (e.g. date (s), nature of crime):

______

Has there ever been a finding against you involving child abuse or maltreatment? Yes____ No ____ If yes, provide details:

______

Please note: A conviction is not an absolute bar to volunteer service but will be considered before accepting offers of service.

Briefly describe your education, skills and/ or previous experience that might contribute to your work in this ministry? ______

______

______

Do you speak any language(s) other than English? YES NO

If Yes, What language (s)? ______

Additional Comments: ______

References

Name: ______

Address: ______

(street) (city) (zip)

Email: ______

Phones:

(Daytime) ______(Evening)______

How do you know this person? ______

How long have you known this person? ______

Name: ______

Address:

______

(street) (city) (zip)


Email: ______

Phones:

(Daytime)______(Evening)______

How do you know this person? ______

How long have you known this person? ______

Name: ______

Address: ______

(street) (city) (zip)

Email: ______

Phones:

(Daytime)______(Evening)______

How do you know this person? ______

How long have you known this person? ______

I CERTIFY THAT THE FACTS CONTAINED IN THIS VOLUNTEER APPLICATION ARE TRUE AND COMPLETED TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS TO DENY ANY OFFER OFSERVICE AND/OR END ANY CURRENT SERVICE.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE PERTINENT INFORMATION.

I ALSO UNDERSTAND THAT I WILL BE REQUIRED TO SUBMIT TO A

BACKGROUND SCREENING AND TO ATTEND THE “SAFE ENVIRONMENT” PROGRAM REQUIRED BY THE DIOCESE OF ALBANY AND/OR OTHER TRAINING PROGRAMS AS REQUIRED.

PRINT NAME: ______

SIGNATURE: ______DATE: ______

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