Catholic Social Services of Southern Nebraska Volunteer Application

Thank you for giving us the gift of your time and talent!

We can't wait to meet you and work together!

Basic Information
Address Line 1
Address Line 2
Postal Code
Home Phone:
Cell Phone:
Preferred phone for contact regarding volunteer opportunities (select one):
Date of Birth:
Your Occupation:
Your Availability:
Are you willing to be on-call?

Emergency Contact
Emergency Contact Name:
Emergency Contact Phone:
Emergency Contact Relation:

Reference Name:
Reference Phone:
Reference Relation:

Volunteer Positions: Check All Areas of Interest
St. Joseph Center
Refugee Program
St. Gianna Women's Homes
Parish and School Opportunities
Areas of Interest Not Listed:

Restrictions/Service hour needs or requirement:

I, the undersigned applicant, do hereby authorize Diocese of Lincoln and Catholic Social Services, by and through its independent 
Contractor, Selection.Com 1-800-325-3609 155 Tri County Pkwy Ste. 150 Cincinnati, OH 45246, to procure an investigative consumer report on me during the application process and at any time during the tenure of my volunteer services with Catholic Social Services. These above mentioned reports include, but are not limited to, personal references; citations; a social security number verification; present and former addresses; criminal and civil history/record.  I understand that I am entitled to a complete and accurate disclosure of the nature and scope of any investigative consumer report prepared on me upon written request to, that is made within a reasonable time after the date hereof. I further authorize any person, business entity or governmental agency who may have information relevant to the above to disclose the same to the Diocese of Lincoln Catholic Bishop of Lincoln, and Catholic Social Services and through Selection.Com, including but not limited to, any courthouse, any public agency, any and all law enforcement agencies and any and all credit bureaus, regardless of whether such person, business entity or governmental agency who compiled the information itself or received it from other sources, including alcohol and controlled substance information from previous employers. 
I hereby release The Diocese of Lincoln Catholic Bishop of Lincoln and Catholic Social Services from any and all liability, claims and/or demands, of whatever kind, to me, my heirs, or others making such claim or demand on my behalf, for assisting with the compilation or preparation of the investigative consumer report hereby authorized.  Disclaimer: Any persons under the natural Age of 19 who require parental signature to the validity of personal identification and/or authorization may be exempt from aforementioned screening check. 
My digital signature attests that I answered all the above information to the best of my knowledge and ability. 

Digital Signature: