Safe Environment Application- Adult

- Resources
Contact Us
- Carole Yaney
  
  Director of Formation, RCIA, & Safe Environment Coordinator
  
  260-432-0268 ext. 107
  cyaneyseasfw.org

VOLUNTEER FORM FOR DIOCESE OF FORT WAYNE-SOUTH BEND
THANK YOU for your interest in volunteering at St. Elizabeth Ann Seton 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 organization that you are volunteering for will be notified.

Complete Training Modules

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.

Five 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 cyaney@seasfw.org. Once you have your ID and Password, click here to begin your training module with Catholic Mutual Group.

Send photo of your driver's license to the parish's Safe Environment Coordinator at cyaney@seasfw.org.

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. Note: This must be done on a laptop or desk top.

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 260-432-0268 or at cyaney@seasfw.org.

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Basic Information
- Volunteer Status REQUIRED Please fill out this field.
- Legal Name (First and last) REQUIRED Please fill out this field. Please enter valid data.
- Other Names Used, Including Maiden Name Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Address (Street 1) REQUIRED Please fill out this field. Please enter valid data.
- Street 2 Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Preferred Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Alternate Phone Number Please enter a phone number.
- Religion REQUIRED Please fill out this field.
- *Please explain
Emergency Contact
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Relationship REQUIRED Please fill out this field. Please enter valid data.

Background Information

Have you previously volunteered or been employed at a diocesan school or any other agency? REQUIRED Please fill out this field.
*If YES, please provide the following additional information.
Name of the school/agency where you worked/volunteered Please enter valid data.
Job(s) performed Please enter valid data.
Start Date Please enter a date.
End Date Please enter a date.
Reason why your volunteer service/employment ended Please enter valid data.
Diocesan School/Agency Supervisor
First Name Please enter valid data.

Last Name Please enter valid data.
Supervisor Phone Number Please enter a phone number.
Have you ever been arrested or convicted of a crime that has not been expunged by court? REQUIRED Please fill out this field.

* 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.

*If YES, please explain Arrest/Conviction:
Have you ever been investigated by a child protection agency? REQUIRED Please fill out this field.
If YES, please explain investigation by Child Protective Services: Please enter valid data.

Interests
- Type of service/activity for which you would like to volunteer * REQUIRED Please fill out this field.
- * If OTHER, please indicate the Area of Service Please enter valid data.
VERIFICATION OF VOLUNTEER APPLICATION
- 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.
  I Agree Please select this field.
- 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 REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Verification Date REQUIRED Please fill out this field. Please enter a date.

Submit

Safe Environment Application- Adult

VOLUNTEER FORM FOR DIOCESE OF FORT WAYNE-SOUTH BEND