Diocese of Laredo New Volunteer Checklist Submit all forms to:

Diocese of Laredo
New Volunteer Checklist
Volunteer Information Form
* Testimonial of Suitability for Volunteer Service/Ministry
(To be completed only by individuals without a Social Security number)
Ethic Acknowledgement Statement
Volunteer Background Check Form
Safe Environment Training Certificate of Completion
(Obtained from online training http://safeandsacred-laredo. org )
All the above forms should be sent to the Human Resources Office
Todos estos formularios deben enviarse a la Oficina de Recursos Humanos
Submit all forms to:
Presentar todas las formal:
Attn: Human Resources Office
1901 Corpus Christi St.
Laredo, Texas 78043
PHONE: (956) 727-2140
FAX: (956) 727-9904
Nom: All entities should maintain a file on all volunteers. These fauns should be secured in
the Administrator's office.
NOTA Todas las entidades deben mantener un archly() de todos los voluntarios. Estos formularios deben ser
asegurados en la oficina del Administrador.
"Only submit if applicable
DIOCESE OF LARED 0
Volunteer Information Form/Formulario de Information de Voluntariado
(Please Print of Type/tetra de molde por favor)
(Use Legal Name/use nombre legal)
Name:
Nombre
SS #
Last/Apellido
FirsVprimer nombre
M/I
Also Known As:
D.O.B
Tambien conocido como
Fecha de nacirniento
Address:
Apt#
Direction
City:
State:
Zip Code:
Ciudad
Estado
Codigo Postal
Home Phone:
(
Work/Cell Phone: f
)
Trabajo / Celular
Telefono de la casa
Name: of Parish, School or Entity:
Ministry:
Nombre de Parroquia, Escuela o Entidad
Volunteer Position:
Start Date:
How Long?
Position Voluntaria
Fecha de Inicio
Cuanto Tiempo
Full Time/Tiempo Completo
Part Time/Tiempo Parcial Number of hours per week
Numero de horas por semana
Work hours:
to
Horas de trabajo
How long have you
known this person?
REFERENCE NAME
Address (City, State, Zip)
Nombre de Referencia
Direccion (Ciudad, Estado, Codigo
Postal)
Daytime Phone
Claim tiempo hace
que conoce a esta
persona?
Telefono durante e1dia
Work/Volunteer Related-/-Trabajo/Voluntarios relacionadas
Work/Volunteer Related-/-TrabajoNoluntarios =beton adoa
=song (Non -Family Member)-/-Pectonal (no roiunbto d. 1. Lanai.)
ersonal (Nan-Faauly Member}/-Persond (no oniernaro de la Emilia
Family Member-/ -Miembro de la familia
EMERGENCY CONTACT INFORMATION:
1NFORMACION DE CONTACTO DE EMERGENCIA:
Name:
Relationship:
Nombre
Relation
Apt#
Address:
Direccion
City:
State:
Ciudad
Estado
Business/Cell Phone :(
Telefono Trabajo/Celular
)
Zip Code
Codigo Postal
Home Phone
(
)
Telefono de Casa
Volunteer Signature
Date
Firma de Voluntario
Fecha
May/2009
Has this person
agreed to provide a
reference?
Esta persona ha
accedido
proporcionar una
referencia?
Diocese of Laredo
Employee/Volunteer Code of Ethics
Employee/Volunteer Name
Date
Nombre de Empleado/Voluntario
Fecha
Church personnel will exhibit the highest Christian ethical standards and personal integrity.
Church personnel will conduct themselves in a manner that is consistent with the discipline and
teachings of the Catholic Church.
Church personnel shall provide a professional work environment that is free from physical,
psychological, written, or verbal intimidation or harassment.
Church personnel will avoid taking unfair advantage of a counseling relationship for their personal benefit.
Church personnel will not physically, sexually or emotionally abuse or neglect a minor or adult.
Church personnel will share concerns about suspicious or inappropriate behavior with their pastor,
their principal, the Diocesan Chancellor, Vicar General or BishOp.
Church personnel will report any suspected abuse or neglect of a minor to the Texas Department
•
of Family and Protective Services.
Church personnel will accept their personal-reSPonSibilitYt° prolebt minors and adults from all
forms of abuse.
*** ** **'** * ** * ** * *** * ** ****** *** * * ******zk ** *** ******** i;*** ** ****** ** *;sc****-*-*** *** * ********
El personal de la Iglesia expondra los estandares etvos cristianos mas altos y la integridad personal.
El personal de iglesia se comportaraen una manera
cOnseCtenth con la disciplina y las
enseflanzas de la Iglesia CatoliCa- :
El personal de iglesia propordionaralin ambiente de trabajo profeSiOnal que es libre de intimidaciOn
e a o acoso
fisica, psicologica, escrita;. Verbal
. . .
El personal de iglesia evitard tciniar la ventaia_injusta de una relacioti orientacion para su ventaja
personal
El personal de iglesia no abusaiaLESicaniente; : kalmente o emocionalmente o descuidard
a un menor o a un adulto
El personal de iglesia compartirkpteOcUpaciOnes poi . el comportamiento sospechoso o inadecuado
con su pastor, su principal, el Canciller Diocesan, • General de Vicario u Obispo
El personal de iglesia relatard cualquier abuso sOipeCliado:o abandono de un menor al Departamento
de Texas de Familia y Servicios ProteCt6i4(TexaSIDePartraent of Family and Protective Services.)
rSonal para proteger a menores de edad y
El personal de la Iglesia aceptara su responsap'.
adultos contra todas las forums de abuso.
que es
v rb l
I have reviewed the Code of Ethics of the Diocese of Laredo and agree to abide by its requirements.
He revisado el codigo de etica de la Diacesis de Laredo y estoy de acuerdo en cumplir con sus requisitos.
Printed Name/imprimir Nombre
Title/rituio
Parish/D ep artrnent/S chool/Other
City/Ciudad
Parroquia / Departamento / Escuela / Otros
S i gnatur e /F irm a
May/2009
Date/Fecha
DIOCESE OF LAREDO
Employee/Volunteer Authorization and Release for the Procurement of a Report
Requestor:
Date
(Name of Parish, School or Entity)
I, the undersigned consumer, do hereby authorize DIOCESE OF LAREDO AND CATHOLIC MUTUAL GROUP, INC. by and througl
independent contractor, LexisNexis, to procure a report on me.
The above mentioned report may include employment and education verification; personal references; citations; a social secu
number verification; present and former addresses and criminal history/record.
I understand that I am entitled to a complete and accurate disclosure of the nature and scope of any report prepared on me up
written request to LexisNexis that is made within a reasonable time after the date hereof and further understand that additional crimir
background checks may be performed periodically during my tenure of employment in the DIOCESE OF LAREDO.
I further authorize any person, business entity or governmental agency that may have information relevant to the above to disclose tt
same to DIOCESE OF LAREDO AND CATHOLIC MUTUAL GROUP, INC. by and through LexisNexis, including but not limited to, ar
courthouse, any public agency, any and all law enforcement agencies regardless of whether such person, business entity c
governmental agency compiled the information itself or received it from other sources.
I hereby release DIOCESE OF LAREDO AND CATHOLIC MUTUAL GROUP, INC., LexisNexis and any and all persons, business
entities and governmental agencies, whether public or private, from any and all liability, claims and/or demands, of whatever kind, tc
me, my heirs, or others making such claim or demand on my behalf, for procuring, selling, providing, brokering, and/or assisting with
the compilation or preparation of the consumer report and/or investigative consumer report hereby authorized.
CRIMINAL HISTORY: THIS INFORMATION WILL BE VERIFIED
Complete Address History for the past 7 years (address; City & State, Zip):
No
No
No
No
Have you ever been convicted of a felony?
Have you ever entered a plea of guilty to a felony?
Have you ever entered a plea of "No Contest" to a felony?
Have you ever been placed on deferred adjudication?
Yes
Yes
Yes
Yes
If you answered yes to any of these questions, please explain:
Volunteer
Employee
SS #
Name:
DL #
Last
PEddle
First
/
City
Address:
Daytime Telephone Number:
Date of Birth
State Issued:
(
/
St
Gender:
Zip
)
Date:
Signature:
FOR OFFthE USE ONLY
This Individual Identified above has
Comments:
Human Resource Staff
.
Not Clear
Cleared
Date:
Please Note: Submit check payable to "Diocese of Laredo"'for the fee of S5 for each form submitted.
May/2009
M F