MISSIONARY CENACLE VOLUNTEERS
( Married
couples,
please fill out separate applications and return in the same envelope)
1. GENERAL INFORMATION (Please Print)
Name:
q Male
q
Female
Current Address
until (__/__/___):
City:
State/Province:
Zip:
Day time phone (
)
Evening phone (
)
Cell
phone ( )
Permanent Address:
Permanent phone number(s) ( )
l How
did you find out about the Missionary Cenacle Volunteers?
l Place
of Birth (city, state/province,
country)
Date of birth
(___/___/______) Citizenship
Social
Security Number
If
you are a lawful permanent resident U.S. immigrant and you received your Work
Visa after January 1987, what is your Registration Number and Card Expiration Date?
If your citizenship is not the U.S., what is your
Visa Type, Number and Expiration
Date?
l Marital Status:
q Single
q Married
q Separated
q Divorced/when
_____ q Widowed
/ when ____
If married, is your spouse applying?
q Yes
q No
Names and ages of any dependents
Names and ages of adult children
Names and ages of any grandchildren
l Your
religious affiliation
Name of Diocesan newspaper
Name and location of parish/local church
What ministries are you involved in there?
l Briefly
describe your physical and mental health
Are
you taking any medicine or receiving any other health care that might continue
during mission service? 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? If
YES, please indicate the company
Have you ever been dependent upon drugs and/or
alcohol? If YES, explain and state how long you have been in recover
Are you now on probation or parole, under charges
for any offense or under any civil suits or judgments pending against you?
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?
2.
EDUCATION & EMPLOYMENT
List
your educational experiences, including high school, beginning with your most
recent experience:
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Name
of School |
Address |
Yrs
Completed |
Date
graduated |
Degree,
Certificate, etc. |
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List
your last four employment
experiences (begin with the most recent) Please
attach a resume, if possible.
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Dates
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Names,
Address & Phone |
Duties |
Reason(s)
for leaving |
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Are you presently unemployed?_________ If yes, please explain
Please
explain any period of time greater than six months not accounted for by work,
school, or military service.
3.
COMMUNITY SERVICE
List your previous volunteer experiences and
community service activities:
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Organization/Activity |
Location |
Description |
Dates |
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4.
SKILLS AND COMPETENCIES
List your skills or experiences that might relate
to volunteer mission service.
List
the kind of skills and level of competencies that you have in the following
areas:
Foreign Language:
Music:
Manual Arts ( carpentry, sewing):
Can you drive a car?_____
Can you type?_____ Can
you use a computer?_____ Can
you cook?_____
Driver’s License
State _____ Expiration
Date_____
Are you
planning to bring a car with you?
5.
PREFERENCES IN MISSION SERVICE
Length of Service
q
9-12
months
q Summer
q Other
Approximate Starting
Date ____/____/____ thru ____/____/____
As a Missionary Cenacle Volunteer, how would you
like to serve? What type of service
do you prefer?
6.
PERSONAL STATEMENT
In addition to all the information that you are
stating in other parts of this application, on
an attached sheet of paper, (please
type or write clearly) tell us,
as thoughtfully and honestly as possible, anything about yourself that might be
helpful in arranging the best mission placement for you.
You might include in this personal statement such items as:
your strengths and weaknesses, the gifts you would bring to mission, your
long-range goals, your reasons for wanting to be a Missionary Cenacle Volunteer,
your relationship with God, your prayer life, your relationship with church and
how spirituality relates to others areas of your life, how your relationship
with God will benefit you and those
around you in your mission experience. Be
sure that you do not duplicate what is already stated in other parts of this
application.
7. REFERENCES
List
the names and addresses of three persons who know you well and who, in
a written narrative reference letter, can attest to your readiness for
volunteer mission service. One must
be a priest or pastor, lay minister
or Religious who knows you spiritually. The
other two references can be from
someone with whom you have worked or studied or perhaps even a friend.
You may send these three letters along with the application, or your
references can be sent directly to
the MCV office.
1) Name:
Relationship:
Street Address:
City:
State/Province:
Zip:
Day time phone (
)
Evening phone (
)
2) Name:
Relationship:
Street Address:
City:
State/Province:
Zip:
Day time phone (
)
Evening phone (
)
3) Name:
Relationship:
Street Address:
City:
State/Province:
Zip:
Day time phone (
)
Evening phone (
)
8.
EMERGENCY CONTACT
Who
should be notified in case of any emergency during mission service?
Name:
Relationship:
Street Address:
City:
State/Province:
Zip:
Day time phone (
)
Evening phone (
)
9.
CERTIFICATION
Before completing the application, please be sure
to note the following items:
q Please include with your application a recent photo of yourself.
q
Have you left any blank items throughout the
application?
q
Have you attached a copy of your resume and your
personal statement?
q
Have you made a copy of the application for your
records?
I hereby certify that all
the above information is true, complete and accurate. If I choose to withdraw my
application for service with MCV, I will notify
the MCV office. Thank you.
Signature: Date:
Please return to :
Missionary
Cenacle Volunteers
P.
O. Box 35105
s
Cleveland
, OH 44135
Phone
(800) 221-5740 s Fax (216) 671-2320
s
Email CenacleVolunteer@aol.com