Please enter your information: (To move to the next field, press [TAB] )

Name: 
Gender: Female  Male
Date of Birth: 
Address: 
              
City:          State:   Zip: 
Phone: (h)   (w) 
Marital Status: Single   Married   Separated   Divorced   Widowed  

In case of emergency, please contact:
Name:  
Relationship:   
Address:        
Telephone #: 
Have you been enrolled in a seminary or religious community?  Yes   No
If yes, Dates: 
Name & Address of Community: 
                                                  
If yes, reason for leaving: 
                                      

Education

High School: 
Address:       
Dates Attended:    Month/Year Graduated: 

College/University: 
Address:                
Dates Attended:        Month/Year Graduated: 
Major:    Minor: 

Graduate School: 
Address:              
Dates Attended:      Month/Year Graduated: 

Trade/Technical School: 
Address:                        
Dates Attended:                Month/Year Graduated: 
Major:    Degree/Cert/Lic: 

Have you served in the military?  No   Yes
If yes, state branch, rank/position and dates of service: 

Employment

List your last three(3) employers starting with present one. Give approximate dates and a brief description of your position.
1. Name & Address: 
Dates & Description: 

2. Name & Address: 
Dates & Description: 

3. Name & Address: 
Dates & Description: 

References

Please list the names of four people who know you well. Do not include relatives. If possible, list individuals who have known you for at least two years.

A person who knows you spiritually (priest, religious or lay person)
Name:        
Address:    
Telephone: 

An employer or supervisor
Name:        
Address:    
Telephone: 

A professor, advisor or counselor
Name:        
Address:    
Telephone: 

A peer you have lived with
Name:        
Address:    
Telephone: 

Do you have a driver's license?Yes  No
If yes, State:    Expires: 
Auto Insurance Carrier: 
Do you plan to use your car during your assignment?  Yes  No

Your Thoughts

Please address the questions completely and candidly. There are no right or wrong answers. Your response is one way for us to know you better and help us to determine an appropriate placement.

Explain your motivation and expectations in becoming a Bon Secours Volunteer.

A Bon Secours volunteer is expected to be "Good Help to those in need". How do you see yourself carrying out that expectation?

Bon Secours volunteers live in Christian communities sharing prayer, meals, and social times. How do you see yourself fitting into a community living situation? What are your hopes and concerns about this? What strengths do you have that will help you address these?

What is your understanding of simple lifestyle? How do you feel about living on a limited budget, sharing resources with others, and living simply?

Describe your prayer life and your relationship with God. How do you take responsibility for your personal growth as a Christian?

How do you deal with stressful situations? How do you handle conflict? Please indicate any information that you believe would be important for us to know.

Although this application places no real obligation either on you or on the Bon Secours Volunteer Ministry Program, it does indicate a serious intention on your part to join the program.