"Application Form for Paid/ Volunteer Roles Involving Children, Young People and Vulnerable Adults - Diocese of Cork & Ross"

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Diocese of Cork & Ross 
APPLICATION FORM FOR PAID/ VOLUNTEER ROLES INVOLVING 
CHILDREN, YOUNG PEOPLE AND VULNERABLE ADULTS 
 
If you have a disability that may make the completion of this form difficult, the form can be completed by someone on 
your behalf however we will still require your signature. 
(Please complete in BLOCK CAPITALS using black ink) 
 
Please state name of Parish,  
Religious Order or Organisation:  
_____________________________________________________________________________ 
 
Role(s) Applied For:  
 
 
_____________________________________________________________________________
 
 
 
 
 
Title: Mr/Mrs/Miss/Ms/Other 
(please specify) 
__________________________ 
 
 
Current Surname:   
_____________________________________________________________ 
 
First Names: 
 
______________________________________________________________ 
 
Name Known By (If applicable): 
__________________________________________________ 
 
Full Address: 
_______________________________________________________________________________________________________________________________ 
 
Preferred Contact Numbers:  ___________________________________________________________________________________________________________________ 
 
Email: 
___________________________________________________________________________________________________________________________________________ 
 
Are you (please tick) 
Employed  
 
Unemployed    
Student  
Homemaker   
 Retired  
 
Other                __________________ 
 
Please tell us something about yourself – any interests or experience you have which are relevant to the 
 
role(s).
 
 
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________ 
 
Have you previously been involved in voluntary work or Church ministry? 
Yes      No     If yes, please give details: 
_______________________________________________________________________ 
_______________________________________________________________________ 
_______________________________________________________________________ 
Have you previously received any training for working with children? 
Yes      No     If yes, please give details. 
_______________________________________________________________________ 
_______________________________________________________________________ 
_______________________________________________________________________ 
 
 
Do you have any current medical conditions you feel we should be aware of in order that we can ensure 
 
your wellbeing whilst you undertake the role(s)?
Diocese of Cork & Ross 
APPLICATION FORM FOR PAID/ VOLUNTEER ROLES INVOLVING 
CHILDREN, YOUNG PEOPLE AND VULNERABLE ADULTS 
 
If you have a disability that may make the completion of this form difficult, the form can be completed by someone on 
your behalf however we will still require your signature. 
(Please complete in BLOCK CAPITALS using black ink) 
 
Please state name of Parish,  
Religious Order or Organisation:  
_____________________________________________________________________________ 
 
Role(s) Applied For:  
 
 
_____________________________________________________________________________
 
 
 
 
 
Title: Mr/Mrs/Miss/Ms/Other 
(please specify) 
__________________________ 
 
 
Current Surname:   
_____________________________________________________________ 
 
First Names: 
 
______________________________________________________________ 
 
Name Known By (If applicable): 
__________________________________________________ 
 
Full Address: 
_______________________________________________________________________________________________________________________________ 
 
Preferred Contact Numbers:  ___________________________________________________________________________________________________________________ 
 
Email: 
___________________________________________________________________________________________________________________________________________ 
 
Are you (please tick) 
Employed  
 
Unemployed    
Student  
Homemaker   
 Retired  
 
Other                __________________ 
 
Please tell us something about yourself – any interests or experience you have which are relevant to the 
 
role(s).
 
 
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________ 
 
Have you previously been involved in voluntary work or Church ministry? 
Yes      No     If yes, please give details: 
_______________________________________________________________________ 
_______________________________________________________________________ 
_______________________________________________________________________ 
Have you previously received any training for working with children? 
Yes      No     If yes, please give details. 
_______________________________________________________________________ 
_______________________________________________________________________ 
_______________________________________________________________________ 
 
 
Do you have any current medical conditions you feel we should be aware of in order that we can ensure 
 
your wellbeing whilst you undertake the role(s)?
Please give names, addresses and telephone numbers of two people who we may contact who have 
known you well for at least 2 years and would be able to comment on your suitability for this role. 
 
 
We cannot accept references from your relatives or family members; your Parish Priest / Curate or members 
of your Diocesan/Religious Safeguarding Team. Please note that only 1 of the 2 required referees may be a 
member of the group/activity to which you are applying to work. 
 
Referee 1  
 
 
 
 
 
Referee 2 
Full Name  
 
 
 
 
 
Full Name 
Full Address  
 
 
 
 
 
Full Address 
 
Preferred Contact 
 
 
 
 
Preferred Contact 
Telephone number(s)  
 
 
 
 
Telephone number(s) 
 
Email Address 
 
 
 
 
 
 Email Address 
 
In what capacity does this person know you?                                  In what capacity does this person know you? 
 
 
 
I give my consent, in accordance with the Data Protection Act 1988, for the information contained in this 
form to be processed and stored for the purposes of recruitment. 
I understand that pre‐appointment Garda vetting checks will be required as part of the recruitment process. 
By making this application I confirm that I am not barred from working with vulnerable groups and 
understand that to apply to work with children/vulnerable adults when barred from doing so is a criminal 
offence. 
In the event that I am not appointed or in the future step down from the post, I understand that relevant 
information will be retained on file until I reach normal retirement age, or for 10 years if that is longer.  
 
I declare that the above information is true and that I am fit to serve as a 
 
__________________________________________________________________ 
 
Signed:____________________________ Date:________________________________ 
 
 
PLEASE RETURN THIS FORM TO: 
 
Full Name:  
 
 
 
 
 
Position: 
Address: 
 
___________________________________________________________________________________ 
  PARISH/RELIGIOUS ORDER OR ORGANISATION USE ONLY: 
 
Date Form Received:____________________________________________ 
Date Ref. Forms Sent:___________________________________________ 
 
Date Ref. 1 Received:___________________________________________ 
Date Ref. 2 Received:___________________________________________ 
 
References Received By:_________________________________________ 
 
Status of Application:____________________________________________ 
 
Invited to take up ministry: Yes / No (please circle) 
 
Signed:_________________________________________________ DATE_______ 
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