Safe Environment Application - Adult

Volunteer Form for Diocese of Fort Wayne-South Bend

THANK YOU for your interest in volunteering at St. Vincent de Paul Catholic Church. The Diocese of Fort Wayne-South Bend requires that all volunteers working with children or teenagers on a regular basis go through a screening process to ensure the safety of the children and teenagers at our parish.

In order to apply to volunteer, please complete the four steps listed below. Once all four steps are completed,your application will be reviewed by the parish's Safe Environment Coordinator, and, if approved, the oganization that you are volunteering for will be notified.

Complete Training Modules
1. New Volunteers: Click here to create an account and begin your training module with Catholic Mutual Group (CMG). For more information about creating an account with CMG, click here.
2. Four Year Renewal Volunteers: You should have received an ID and PASSWORD when you were informed that your volunteer status was up for renewal. Please use the ID and Password given. PLEASE DO NOT CREATE A NEW ACCOUNT. If you have forgotten the ID or Password, please email the Safe Environment Coordinator at safe-env@saintv.org or click here. Once you have your ID and Password, click here to begin your traning module with Catholic Mutual Group
Please email a picture of your driver's license to the parish's Safe Environment Coordinator at safe-env@saintv.org or click here.
Complete and Submit the Volunteer Application below.
Request Criminal History by clicking the link that appears after submitting your Volunteer Application in step 3 above.

Please note that completing the application process does not guarantee that you are able to participate as a volunteer with children or teenagers at the parish. If you have any questions, please contact the parish staff member with whom you are volunteering or the parish's Safe Environment Coordinator in the parish office at (260) 489-3537.

Basic Information

Volunteer Status

Required*

Legal Name

First Name*

Last Name*

Other Names Used, including Maiden Name

Date of Birth

Required* //

Required*

Address

Street 1*

Street 2

City*

State*

Zip*

Preferred Phone

Required* --

Alternate Phone

Religion

Required*

*Please explain

Emergency Contact

Name

First Name*

Last Name*

Phone

Required* --

Relationship

Required*

Background Information

Have you previously volunteered or been employed at a diocesan agency?

Required*

* If YES, please provide the following additional information:

Name of the school/agency where you worked/volunteered

Job(s) performed

Start Date

End Date

Reason why your volunteer service/employment ended

First Name

Last Name

Diocesan School/Agency Supervisor

Supervisor Phone --

Have you ever been arrested or convicted of a crime that has not been expunged by court?

Required*

* If you have ever been arrested for or convicted of a crime, other than a non-moving traffic offense, please indicate the nature, date and place of each arrest or conviction; sentence received; sentence served; the name of any probation or parole officer; and, any other facts or circumstances that you wish to provide below.

Arrest/Conviction details

Have you ever been investigated by a child protection agency?

Required*

Message

*If yes, please explain below.

Child Protection Agency Details

Interests

List (Dropdown)	Type of Service/Activity for which you would like to volunteer *
	* Please indicate the Area of Service

VERIFICATION OF VOLUNTEER APPLICATION

Required*

I certify the information contained in this application is true and complete. I acknowledge that if I am accepted as a volunteer, I have continuing obligation to immediately notify the diocese of any changes or new information referred to on this application. I authorize the diocese, its employees, and agents to undertake an investigation that it deems appropriate in connection with this application and agree to cooperate with that process. I understand that such investigation may include, among other things, conducting a criminal history check on me. I understand that the diocese is under no obligation to accept me as a volunteer. I further understand that the diocese will not accept me for a volunteer position if I fail to complete this application, or if any of the information that I have proved on it or discovered by the diocese renders me unacceptable for a volunteer position, as determined solely by the diocese. I understand that if I am accepted for a volunteer, I must complete the diocese's Safe Environment Education Process before engaging in any volunteer work for the diocese. Further, I am bound to comply with all diocesan rules, directives, policies, procedures, etc., including but not limited to those concerning Church teachings, morals, and personal conduct. I acknowledge that, in the event I am accepted for a volunteer position, the diocese has the right to utilize my volunteer service as it deems necessary and to terminate my volunteer service at any time.

FINAL VERIFICATION

By typing my name and submitting this application, I certify that I am the person who is applying for the volunteer position on this application form.

First Name*

Last Name*

Verification Date

Required* //

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Safe Environment Application - Adult

Volunteer Form for Diocese of Fort Wayne-South Bend

Emergency Contact

VERIFICATION OF VOLUNTEER APPLICATION

FINAL VERIFICATION

Online Giving