Volunteer Application
Date:

Address: 740 E. 17th Street
Minneapolis, MN 55404
Website Address: www.ccspm.org
E-mail: Volunteer@ccspm.org
Volunteer Info Line:(612) 664-8600
Fax: (612) 375-9105

Answers to the following questions help us
provide the most appropriate placement for you.
This information will be kept confidential.

CONTACT INFORMATION
Mr. Mrs. Ms. Dr.
First Name: (Required)
Last Name: (Required)
Address:
 
City:
State:
Zip:
Home Phone:
Work Phone:
Fax:
E-Mail Address: (Required)

EMPLOYMENT
Job Title (if employed):
Employer Name:
Business Address:
Business City:
Business State:
Business Zip:
   
May we contact you at work? Yes No
Contact Hours? to
 
Does your employer offer a Corporate Contributions for Volunteer hours program? Yes No
   
Person to contact in case of emergency:
Emergency phone:
Relationship to you:

EDUCATION INFORMATION
What is the highest level of education completed?
H.S.
A.A.
Trade School
B.A. / B.S.
Masters / J.D.
PhD

Are you currently a student? Yes No

What school did you attend or are attending?

What was or is your area of study?

INTERNSHIPS AND REQUIRED HOURS
Do you have requires hours to complete? Yes No
If Yes, how many?

What are the required hours for?
Internship Level of supervision needed:
  BSW MSW LAMFT Other
Graduation Requirement
Court Ordered
  What offense was committed?
   
When do you need to complete your hours? M/D/YY

Volunteer opportunities which interest you (in order of preference):
Please note: Not all opportunities are open at all times. Certain positions require training and/or have additional eligibility requirements. Some positions may also require a reference check.
1.
2.
3.
4.

EXPERIENCE
Have you volunteered or worked with Catholic Charities before?
Yes No
If yes, in what capacity?
When?
Where?
What program?

Describe any relevant previous volunteer experience, work experience, or internships you have had:

Do you have any special training or skills that
you would like to share or use:
CPO
EMT
CAN
CDL
CPA
Legal
Language 1
Language 2
Language 3
Teaching License
Trade
Craft

If you have a license, when does it expire?

Do you have any physical disabilities or health concerns that would prevent you from performing certain kinds of work or in a certain work environment? Yes No
If Yes, please explain:

AVAILABILITY:
Please check all applicable times and locations
you are willing and available to volunteer:
Time of day: Mornings Afternoons
Evenings Nights
Time of week: Weekdays Weekends
Time of year: Fall Winter Spring Summer
Preferred location: East Metro/ St. Paul West Metro/ Minneapolis
Counties: Anoka Washington Dakota Scott
Carver Wright Sherburne

Personal or Professional References (please exclude relatives)
Our policies require that 3 of 4 reference records be on file before you can be placed in a volunteer position. Please provide four references who know you and who are not relatives. These records will be kept confidential.

1. Name
  Phone
  Address
  City
  State
  Zip
  How long have you known this person?
  Relationship:

2. Name
  Phone
  Address
  City
  State
  Zip
  How long have you known this person?
  Relationship:

3. Name
  Phone
  Address
  City
  State
  Zip
  How long have you known this person?
  Relationship:

4. Name
  Phone
  Address
  City
  State
  Zip
  How long have you known this person?
  Relationship:

Please help us in our recruitment efforts by telling us
how you heard about our volunteer/intern opportunities.
Please check the one that best fits:
CC Volunteer / Employee
Church
Civic Organization
Corporation
School
Donor
Current / Former CC Client
Friend / Relative
CC Website
Newspaper
Radio
United Way
Other Social Service Provider
Hands on Twin Cities
Volunteer Match
Other

REASON FOR INVOLVEMENT
Why are you interested in volunteering at Catholic Charities at this time?

Please provide any further information that would help us determine how we can appropriately match your interests:

Release of Information
By signing this application you acknowledge and assent that you are applying to Catholic Charities for a volunteer/ intern position and that these positions require references to be contacted, so that Catholic Charities will be fully advised as to your qualifications. You, therefore, release all references from any and all liability of damages for providing the information requested. You understand that this information will be kept confidential. Finally, you further authorize your signature to be duplicated for purposes of this information request, and acknowledge that duplicate copies of this request are valid.

Statement of Veracity and Acknowledgement
I hereby certify that the facts set forth in the above application are true and complete to the best of my knowledge. I understand that completing this application does not ensure a volunteer or internship placement. I also understand that this is not an application for paid employment.

Applicant’s Signature
Date: