Catholic Kids Net Inc. First-Time Participant ApplicationWhich program are you applying for?(Required) Captivenia Arcãtheos Both Contact InformationName(Required) First Last Phone(Required)HomeMobileEmail(Required) Enter Email Confirm Email Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Religious Affiliation(Required)ReligionChurch or ParishPhoto UploadPlease upload a simple portrait photograph of yourself.Accepted file types: jpg, png, pdf, Max. file size: 64 MB.PositionHave you ever participated in a program with Catholic Kids Net, Inc.?(Required) YES NO What position are you applying for?(Required) What interests you about the position for which you are applying?(Required)What has prepared you for the positions for which you are applying?(Required)What are some of the gifts and talents you would like to share?(Required)HistoryEducation HistoryStart & end datesSchool name & addressType of SchoolName of program/degreeProgram complete? Add RemoveComplete for the highest level of education to date. Please start with the most recent and be as specific as possible.Employment HistoryPlease start with the most recent and be as specific as possible.Start & end datesCompany name & addressImmediate supervisor name & phone numberPosition heldReason for leaving position Add RemoveVolunteer/Ministry/Service HistoryList 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 datesOrganization name & addressImmediate supervisor name & phone numberPosition held Add RemoveReferences(Required)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 nameAddressDaytime phoneHow long have you known this person?Has this person agreed to provide a reference? Add RemoveHave you ever been accused of physically, sexually, or emotionally abusing a child or an adult?(Required) YES NO Please explain:(Required)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 Camp Program Policy & Procedures 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. Consent I acknowledge that my electronic signature below indicates that I have read, understand and agree to comply to all the above. Participant Signature(Required)Name(Required) First Last Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920PhoneThis field is for validation purposes and should be left unchanged.