Missionary Cenacle Volunteers

Application for Long-Term Volunteer Mission Service

Step #1: General Information

(Married couples, please fill out separate application and return in the same envelope.

• How did you find out about the Missionary Cenacle Volunteers?

  What was your first contact with the program?

  Do you currently have an application pending with another volunteer program?   Yes   No   If yes, please give the name of the volunteer program (s) and the present status. 

• Place of Birth:

  City:
  State:
  Country:
  Date of Birth:
  Citizenship:
  Social Security Number:

        If you are a lawful permanent resident U.S. immigrant and your received your Work Visa after January 1987 please provide your:     

        If your citizenship is not the U.S., what is your:

• Marital Status:

  Single:
  Married:
  Separated:
  Divorced/When:
  Widowed/When:
  If married, is your spouse applying?
  Names and ages of dependents:
  Names and ages of adult children:
  Names and ages of grandchildren:

• Religion:

  Your religious affiliation:
  Name of Diocesan newspaper:
  Name of Parish/local church:
  Location of Parish/local church:
  What ministries are involved in there?

• Health:

  Briefly describe your physical and mental health:
  

  Are you taking any medicine or receiving any other health care that might continue during mission service?  Yes    No
  If YES, please describe:
  

  Describe any physical or mental condition that might affect your mission service.
  

  Do you have any health insurance that might be continued during mission service?  Yes    No   
  If YES, please indicate the company and the policy ID#.
  

  Have you ever been dependent upon drugs and/or alcohol?  Yes    No
  If YES, explain and state how long you have been in recovery.
  

  Have you ever pleaded guilty to, pleaded no contest to, or been convicted of a civilian or military crime?  Yes    No
  If YES, explain.
  

  Are you now on probation or parole, under charges for any offense or under any civil suits or judgments pending against you?  Yes    No
  If YES, explain.
  

  As part of the application process and for the protection of those we serve, would you authorize MCV to conduct a criminal background check?  Yes    No

Thank you for completing Step 1 of the Missionary Cenacle Volunteer application.  When you click submit, you will be taken to Step 2.  Please feel free to continue the application or return at a later time to continue.

(Please click submit only once.)