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your information: (To move to the next field, press [TAB] )
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ABOUT YOU |
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Name |
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Gender |
Female
Male |
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Date of Birth |
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Email |
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Present Address |
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Present Phone Number |
(AREA CODE) PHONE |
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Permanent Address |
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Permanent Phone |
(AREA CODE) PHONE |
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Marital Status |
Single
Married
Separated
Divorced
Widowed |
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In case of emergency, please contact
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Name |
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Relationship |
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Address |
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Telephone |
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EDUCATION |
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High School |
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Address |
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Dates Attended |
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Month/Year Graduated |
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College/University |
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Address |
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Dates Attended |
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Month/Year Graduated |
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Major |
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Minor |
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Graduate School |
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Address |
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Dates Attended |
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Month/Year Graduated |
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Major |
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Minor |
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Trade School |
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Address |
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Dates Attended |
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Month/Year Graduated |
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Major |
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Degree/Cert/Lic. |
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SKILLS |
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Foreign Language |
Fluent Good
Fair
N/A |
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Foreign Language |
Fluent Good
Fair
N/A |
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Are you/will you be certified in the
health care field? |
Yes
No |
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If Yes, explain |
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MILITARY SERVICE |
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Have you served in the military? |
Yes
No |
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If Yes, state branch, rank/position and
dates of service |
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EMPLOYMENT |
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List your last three (3) employers
starting with the present one. Give approximate dates and a brief
description of your position. |
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1. Name & Address |
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Dates & Description |
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2. Name & Address |
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Dates & Description |
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3. Name & Address |
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Dates & Description |
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REFERENCES |
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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. |
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Name |
An employer or supervisor
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Address |
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Phone |
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Name |
Professor, advisor, counselor, mentor,
past volunteer coordinator,
or pastor
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Address |
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Phone |
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Name |
Professor, advisor, counselor, mentor,
past volunteer coordinator,
or pastor
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Address |
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Phone |
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Name |
A peer you have lived with
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Address |
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Phone |
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How did you hear about this program? |
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Do you have a drivers license? |
Yes
No |
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If yes, list State |
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License expires |
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Auto Insurance Carrier |
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Do you plan to use your car during your
assignment? |
Yes
No |
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YOUR THOUGHTS |
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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.
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A Bon Secours volunteer is expected to be "Good Help to those in need".
How do
you see yourself carrying out that expectation?
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Bon Secours volunteers live in communities sharing
reflections, meals, chores, 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?
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What is your understanding of simple lifestyle?
How do you feel about living on
a limited budget, sharing resources with others, and living simply?
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How does your life relate to the Bon Secours
Mission Statement as follows: Having experienced God’s call to live Christian
gospel values, we, the Bon Secours volunteers, commit ourselves to support one
another on our spiritual journey. Sharing the mission of the Sisters of Bon
Secours, we extend the healing ministry of Christ to those in need, so that we
may deepen our relationship with God, self and others.
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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.
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Although this application places no legal 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. |
