SE Application for Religious Education Volunteer
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Name: *
Age: *
Required
Address: *
Cell Phone Number: *
Home Phone Number:
Email address: *
Emergency Contact (name and phone): *
Do you have any allergies?  If yes, what are they?
What is your present employment?
Are you a Catholic in good standing?  If no, please explain:
How many years have you been a member of the parish of St. Ann's?
Former parish:
Why are you applying to the catechetical ministry?
CATECHETICAL BACKGROUND
Have you ever been a catechist?  If yes, how many years?
Are you certified as a catechist?  What diocese?
Clear selection
Last parish where you taught:
List any volunteer projects you have taken part in during the past five years:
EDUCATIONAL BACKGROUND
Elementary School District
Middle School District
High School and year of graduation (if graduated)
College and number of years attended:
Major, degree, and year of graduation:
Other studies and years of study:
RELIGIOUS EDUCATION BACKGROUND
Elementary School - where did you receive your religious education?
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High School:
Clear selection
College (if applicable)
Clear selection
Graduate Studies:
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List any Adult Religious Education courses, workshops, seminars attended (if applicable):
REFERENCES
Give TWO character references from people, preferably an employer, co-worker, or friend, who have known you for two or more years (include name, address, and phone number of references):
If the answer to any of the following questions is "yes", please explain on a separate sheet:
Have you ever been convicted of a crime? (Please note that the Archdiocese will comply with all relevant federal, state and local laws regarding the use of information about criminal convictions for employment purposes):
 *
Has a civil or criminal complaint ever been filed against you alleging child neglect or abuse of any kind? 
 *
Have you ever been terminated or disciplined in your employment for reasons relating to allegations of physical abuse or sexual misconduct by you? 
 *
Have you ever been accused of or investigated for an act of sexual abuse or harassment of any kind?
 *
I hereby certify...
I hereby certify that the information I have provided in the Safe Environment Questionnaire, and any attached documents, is complete, true, and correct to the best of my knowledge.

I understand that it is my responsibility to comply fully with the Safe Environment Requirements of the Archdiocese of New York within 45 days of commencing my service with an Archdiocesan institution. I understand that these requirements include submitting to a background check and completing the appropriate Safe Environment Training program. I also understand that full compliance with these requirements is a condition of any volunteer service or employment with an Archdiocesan institution that involves regular contact with minors, and that failure to comply will result in my being barred from any contact with minors in any Archdiocesan institution.

I further acknowledge that I have received the Summary of the Archdiocese of New York’s Policy onSexual Misconduct and the Code of Conduct. I understand their meaning, and agree to conduct myself in accordance with their terms. I acknowledge that the Policy is not intended to create any contractual obligations, express or implied, on the part of the Archdiocese of New York or its affiliated entities. 
Name: *
Date: *
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Safe Environment Requirements by Age:
All new applicants for positions with an Archdiocesan institution (18 years old and older), whether paid or volunteer, whose position or duties would place them in regular contact with minors, must fully comply with the following Safe Environment requirements:
  • Complete the Personnel Screening Process (i.e., complete the Safe Environment Questionnaire, submit to a background check, and acknowledge receipt of the Archdiocesan Policy Relating to Sexual Misconduct, and the appropriate Code of Conduct); and
  • Complete the Safe Environment Training appropriate to their position.
Volunteers who are under 18 may be in regular contact with children only if they are directly supervised by an adult who is in full compliance with the Safe Environment Requirements and who is actually present at the time and place where they are serving.

Age 16 or 17:  complete a Safe Environment Questionnaire, submit to a background check (with parental consent), and attend a "Safer Spaces" class after the background check has been submitted. Review the Code of Conduct.

Age 14 or 15:  complete a Safe Environment Questionnaire, and attend a "Safer Spaces" class, but do not have to submit to a background check.   Review the Code of Conduct.

Under the age of 14:  do not have to submit to a background check or attend a training class, but must be advised of the Code of Conduct.
 
What if a person doesn’t have a valid Social Security number? Do they still have to have a background check?
Yes.  We still have to verify their identity and check their background. If a person does not have a valid Social Security number, please complete the background check authorization form, leaving the line for Social Security number blank. The pastor, principal or Director of Religious Education should verify their identity with some form of photo identification (e.g., a driver's license, a passport, an employer-issued ID card, etc.). The pastor, principal or DRE should then send our Office the authorization form, along with a copy of the identification document.
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