2021 Adult Participant Application

Catholic Kids Net, Inc.

2021 Adult Participant Application
Contact Information
Name*
First Middle Last Maiden
Phone*
Home Mobile
Email*
Date of Birth*
MM slash DD slash YYYY
Photo Upload*
Please upload a simple portrait photograph of yourself.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Religion*
Parish*
Position
Have you ever participated in a program with Catholic Kids Net, Inc.?*
- Yes
- No
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What was your position/role?
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Dates
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What position are you applying for?*
What interests you about the position for which you are applying?*
What has prepared you for the positions for which you are applying?*
What are some of the gifts and talents you would like to share?*
History
Education History
Complete for the highest level of education to date. Please start with the most recent and be as specific as possible.
Start & end dates School name & address Type of School Name of program/degree Program complete?
Employment History
Please start with the most recent and be as specific as possible.
Start & end dates Company name & address Immediate supervisor name & phone number Position held Reason for leaving position
Volunteer/Ministry/Service History
List all paid and volunteer positions involving work with or around minors you have held, either with Church or non-Church organizations (e.g., Girl Scout leader, religious education instructor, youth minister, coach, etc.). Please start with the most recent and be as specific as possible.
Start & end dates Organization name & address Immediate supervisor name & phone number Position held
References*
Please provide names and contact information for two references as follows: (1) Employment Supervisor or Ministry Supervisor or Parish Priest and, (2) Personal reference (non-family member). These individuals may be contacted by Catholic Kids Net Inc. and/or their designee.
Reference name Address Daytime phone How long have you known this person? Has this person agreed to provide a reference?
Have you ever been accused of physically, sexually or emotionally abusing a child or an adult?*
- YES
- NO
Please explain:*
Carefully review each of the following statements:
- I declare that all statements contained in this application are true and that any misrepresentation or omission is cause for rejection of my application, or dismissal from this program.
- I acknowledge receipt of the CKNET SAFE ENVIRONMENT POLICY& PROCEDURE MAUAL and I agree to observe all of the guidelines and policies of this program.
- I understand that it is my responsibility to read and comply fully with Catholic Kids Net Inc. Safe Environment Requirements before the commencement of volunteer/ministry work in any program.
- I authorize this program to conduct a personal and professional background check for the purposes of my application.
- CKNet, Inc. may contact any references, past and current employers, church, youth organizations, agencies where volunteer service has been completed, and any individual or organization that might be relevant to my desired position.
- I hereby release all of the persons listed above from any and all liability for damages that might occur during the Catholic Kids Net Inc. contact with the individuals for purposes of employment or volunteer services screening.
- I waive all rights to inspect information provided about me by the persons previously mentioned. I have also read and understood the information stated above in this release and am signing below of my own free will.
- I understand that I must provide an original Criminal Record Check for Vulnerable Sector, in addition to an Intervention Record Check (or equivalent) specifically for Catholic Kids Net Inc. Failure to comply will result in my being barred from any contact with minors in all Catholic Kids Net Inc. programs.
- I understand that Catholic Kids Net Inc. has ZERO TOLERANCE FOR ABUSE and takes all allegations of abuse seriously. I further understand that Catholic Kids Net Inc. cooperates fully with the authorities to investigate all cases of alleged abuse. Abuse of minors is grounds for immediate dismissal and possible criminal charges.
- I declare that I have not perpetrated physical abuse, sexual abuse, emotional abuse, or neglect against a minor or a vulnerable adult, and that I have never been accused of these acts.
- I understand that I can withdraw from the application process at any time.
- I understand and agree that false statements and/or omissions regarding past conduct and/or present situation may be grounds for denial of the application to provide employment and/or volunteer services, and that refusal to inform this program of the contents of a sealed criminal record will result in the automatic denial of the application.
- I agree to adhere to Alberta Public Health Regulations in effect during the camp/program, as required for group gatherings and overnight camps (i.e. Covid-19 restrictions, if any).
Consent
I acknowledge that my electronic signature below indicates that I have read, understand and agree to comply to all the above.
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Participant Signature*
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Name*
First Last
Date*
MM slash DD slash YYYY
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Start & end dates	School name & address	Type of School	Name of program/degree	Program complete?

Start & end dates	Company name & address	Immediate supervisor name & phone number	Position held	Reason for leaving position

Start & end dates	Organization name & address	Immediate supervisor name & phone number	Position held

Reference name	Address	Daytime phone	How long have you known this person?	Has this person agreed to provide a reference?

Catholic Kids Net, Inc.

2021 Adult Participant Application

Contact Information

Position

History

Carefully review each of the following statements:

Consent

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