* Required Fields
Personal Information
* First Name:
* Last Name:
* E-mail:
Gender:
Select One
Female
Male
Contact Information
Present Address
* Address:
* City:
* State:
* Zip:
* Phone: (Area Code)Phone#
Date address is no longer valid: (MM/DD/YY)
Permanent Information (if different from above)
Address:
City:
State:
Zip:
Phone: (Area Code)Phone#
Emergency Contact
First Name:
Last Name:
Relationship:
Address:
City:
State:
Zip:
Phone:
(Area Code)Phone#
Education
High School:
Address:
City:
State:
Zip:
Dates Attended:
Month/Year Graduated:(mm/yy)
College/University:
Address:
City:
State:
Zip:
Dates Attended:
Month/Year Graduated:(mm/yy)
Major:
Minor:
Graduate School:
Address:
City:
State:
Zip:
Dates Attended:
Month/Year Graduated:(mm/yy)
Major:
Minor:
Trade School:
Address:
City:
State:
Zip:
Dates Attended:
Month/Year Graduated:(mm/yy)
Major:
Degree/Cert/Lic.:
Skills
Are you / will you be certified in the health care field?
No
Yes
(If yes, explain
)
Foreign Language(s): (List )
Select One
Fluent
Good
Fair
N/A
Select One
Fluent
Good
Fair
N/A
Select One
Fluent
Good
Fair
N/A
Military Service
Have you served in the military?
Yes
No
Honorable Discharge?
Yes
No
If Yes, state branch, rank/position and dates of service.
Employment History
List your last three (3) employers
starting with the present one.
Give approximate dates and a brief
description of your position.
Employer (1):
Address:
City:
State:
Zip:
Dates Employed
To :(MM/YY)
From:(MM/YY)
Describe Duties Performed:
Employer (2):
Address:
City:
State:
Zip:
Dates Employed
To :(MM/YY)
From:(MM/YY)
Describe Duties Performed:
Employer(3):
Address:
City:
State:
Zip:
Dates Employed
To :(MM/YY)
From:(MM/YY)
Describe Duties Performed:
Area of Interest
Bon Secours Volunteer Ministry specializes in health care, education, and social service. Please indicate your primary area of interest and please check some positions which seem to fit your talents and interests.
Rank your top three choices of ministry, by placing a “1” next to your first choice, “2” next to your second and “3” next to your third .
Health Care
Education
Social Service/ Human Services
Health Care
Public health education in the community/Parish Nursing – Tele-Heart Program.
Assist in the Cardiology Department at Bon Secours hospital.
Assist in the Emergency Department at Bon Secours hospital.
Assist in the Vascular Lab at Bon Secours hospital.
Assist in the Physical Therapy Department at Bon Secours hospital.
Other health related
Select One
Nursing
Mental Health Department
Other
Education
Serve as a teaching assistant at a tuition-free Catholic middle school for young women.
Minister at a learning center for developmentally disabled adults.
Serve young mothers seeking their GED and their children at a family resource center.
Social Service/Human Services
Assist at a day program for homeless women
Working with young parents seeking their GED and their children at a family resource center.
Serving in the Social Work department at a hospital which serves those facing economic injustice.
No preference/do not know at this time
References
Please list the names of four people whom you intend to ask to serve as a reference. Do not include relatives. If possible, list individuals who have know you for at least two years. A reference form specific to each individual’s role is available on the website. You will include our reference forms from these individuals with the secondary application.
Title: Professor
Name:
Address:
City:
State:
Zip:
Phone: (Area Code)Phone#
Title
Select One
Youth Minister
Advisor
Campus Minister
Mentor
Past Volunteer Coordinator
Pastor
Name:
Address:
City:
State:
Zip:
Phone: (Area Code)Phone#
Title
Select One
Employer
Supervisor
Name:
Address:
City:
State:
Zip:
Phone: (Area Code)Phone#
List a Peer with whom you have lived for, at least, a year.
Name:
Address:
City:
State:
Zip:
Phone:
(Area Code)Phone#
Other Information
How did you hear about this program?
Select One
Volunteer Fair
Website
Word of Mouth
Response Book
Connections Book
Other (specify)
Other:(specify)
Automotive Information
Do you have a drivers license?
Yes
No
If Yes, what state.
License expires:(MM/YYYY)
Do you plan to use your car during your assignment?
Yes
No
Essays
Essays: Why are you applying to Bon Secours Volunteer Ministry?
Please address the questions completely and candidly. Your responses are one way for us to know you better and to help us determine an appropriate placement. Feel free to expand on any questions asked.
Essay 1: Please explain your motivation and expectations for becoming a Bon Secours Volunteer.
Essay 2: How do you see yourself participating in the Sisters of Bon Secours’ commitment to justice in radical solidarity with the poor, the suffering, and those most in need?
Essay 3:
. How will you share compassion, healing, and liberation, the charism of the Congregation of Bon Secours, with others? How might this sharing the healing ministry of Christ, particularly to those in need, deepen your relationship with God, with yourself, and with others.
Essay 4: Bon Secours volunteers live in an intentional community where they share reflections, meals, chores, and social times. How do you see yourself fitting into a community living situation? What are your hopes and concerns about this? What strengths do you have that will help you address these concerns?
Essay 5: What is your understanding of a simple lifestyle? How do you feel about living on a limited budget, sharing resources with others, and living simply?
Please include any additional information that you believe would be important for us to know.
Although this application places no legal obligation either on you or on the Bon Secours Volunteer Ministry Program, it does indicate a serious intention on your part to join the program.