
Please put together an application that includes all of the following information. Don't forget to print out and sign the release statement!
Name
Current Address
Phone number
Social Security Number
Date of Birth
Church affiliation
Date available to join community
Have you ever been prosecuted, indicted or convicted of any crime including misdemeanors or felonies? Is so, state the charge or explain the circumstances.
As part of the application process, we wish to receive:
Please write a brief autobiography addressing key points in your life. Describe who you are as a person and talk about your spiritual development- both past, present and goals for the future. Please include past experience with youth.
You may choose to address one or more of these questions in your autobiography. If so, please note that we may find your answer there.
Professional (or volunteer position)
name
organization
phone number
Pastor or spiritual director
name
organization
phone number
Personal
name
phone number
I hereby certify that the information provided in my application is freely given, true and complete. I understand that any false statements or misleading information may be sufficient grounds for immediate disqualification at any time. I also understand that Lane County Catholic Worker will conduct a criminal background investigation. I authorize any employer, reference and anyone contacted by Lane County Catholic Worker herein to release pertinent information about me in referent to the job that I will be performing including the way that I interact with others. I hereby release Lane County Catholic Worker from any liability or damage which may result from obtaining the information requested.
Signature
Date