Volunteer Form
  • Personal Information
    • First Name:*
       
    • Middle Name:
       
    • Last Name:*
       
    • Home Address 1:*
       
    • Home Address 2:
       
    • City:*
       
    • State:*
       
    • Zip*
       
    • Home Phone:*
       
    • Work Phone:
       
    • Cell Phone:
       
    • Email:*
       
    • Date of Birth:*
       (MM/DD/YYYY)  
    • Last 4 of SSN:*
       
    • Driver's License Number*
       
    •  
  • Program Interest
    (Please select all programs you are interested in serving)
    • Emregency Aid
      Yes
      No
    • Representative Payee
      Yes
      No
    • Immigration/Refugee Services
      Yes
      No
    • Office for Persons with Disability
      Yes
      No
    • Family & Individual Counseling
      Yes
      No
    • Housing Counseling/ Family Self-Sufficiency
      Yes
      No
    • First Call
      Yes
      No
    • Healthy Living Center
      Yes
      No
    • Mother Teresa Shelter, Inc.
      Yes
      No
    • Reception
      Yes
      No
    • Do you have any limitations that would impair your ability to perform as a volunteer? *
      (If yes, please explain below)
      Yes
      No
    • If yes, please explain:
    •  
  • Employment Information
    • Are you currently employed?*
      (If yes, please complete information below)
      Yes
      No
    • Employer:
       
    • Address 1:
       
    • Address 2:
       
    • City:
       
    • State:
       
    • Zip
       
    • Describe job duties:
    •  
  • Volunteer Experience
    • Preference of duties:
      (please explain)
    • Languages spoken
      (other than English)
    • Languages written
      (other than English)
    • Are interested in serving as a Sign Language Interpreter?*
      Yes
      No
    • Are interested in serving as a Braille Interpreter?*
      Yes
      No
    • Have you ever been convicted of a crime?*
      (If yes, please explain below)
      Yes
      No
    • Explanation:
    •  
  • Previous Volunteer Experience 1
    • Name of Volunteer Program
       
    • Date
       (MM/DD/YYYY)  
    • Types of Duties Performed
    •  
  • Previous Volunteer Experience 2
    • Name of Volunteer Program
       
    • Date
       (MM/DD/YYYY)  
    • Types of Duties Performed
    •  
  • Previous Volunteer Experience 3
    • Name of Volunteer Program
       
    • Date
       (MM/DD/YYYY)  
    • Types of Duties Performed
    •  
  • Education
    • High School Diploma*
      Yes
      No
    • Year:
       
    • List any other training, certifications, or porfessional licenses completed:*
    •  
  • Volunteer Shifts
    Please list the day of the week you are available to volunteer
    • 8:00 am - 10:00 am
        Write M, T, W, TH, F
    • 10:00 am - 12:00 pm
        Write M, T, W, TH, F
    • 12:00 pm - 2:00 pm
        Write M, T, W, TH, F
    • 2:00 pm - 4:00 pm
        Write M, T, W, TH, F
    •  
  • Emergency Contact Information
    • Name:*
       
    • Relationship:*
       
    • Home Phone:*
       
    • Work Phone:
       
    •  
  • Reference 1
    (All candidates will be required to undergo drug and criminal history screening)
    • Phone:*
       
    • Name:*
       
    • Relationship:*
       
    •  
  • Reference 2
    • Phone:*
       
    • Name:*
       
    • Relationship:*
       
    •  
  • Reference 3
    • Phone:*
       
    • Name:*
       
    • Relationship:*
       
    •  
  • APPLICANT’S STATEMENT AND AUTHORIZATION TO RELEASE
    I certify that all of the above information is correct and true to the best of my knowledge. I further understand that false or misleading information may be grounds for rejection of my application. I hereby give Catholic Charities of Corpus Christi, Inc. permission to conduct a background check as well as contact any of my references.
    • I hereby acknowledge that I have read and understand the above statements.*

    •  
  • Security Code*

    (Enter the code above)
  •  
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