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, candidly and on a
separate sheet of paper. 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.

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


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

3. 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?

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

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

6. 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, 
t does indicate a serious intention on your part to join 
the program.

Please mail to:
	Bon Secours Volunteer Ministry
	Eileen Kiefer, Director
	1525 Marriottsville Road
	Marriottsville, MD  21104