Notre Dame School
Volunteer Screening Form
Welcome to the Online Screening Form Program. The information you submit is private and secure. The data will only be sent to the Safety Director, and the Social Security Number is encrypted. The Safety Director for Notre Dame School is Diana E. Bosworth. Fax number is: 214-720-3913.
Fill out the form.
Click on the "Submit" button.
Check the data to make sure everything is correct.
Click on the back arrow to make changes or the Continue button to proceed.
The last page will be displayed.
Please note that:
An * shows required fields.
Phone numbers can be entered in any of the following formats:
ddd-ddd-dddd ddd.ddd.dddd ddd ddd dddd
(ddd) ddd-dddd dddddddddd
This form is to be completed for all applicants for any position (volunteer or compensated). This is not an employment application. Persons seeking employment will be required to provide additional information. This process is used to help the church provide a safe and secure environment for children, youth and adults who participate in our program and use our facilities.
Volunteer means any unpaid person engaged in or involved in a Diocesan activity, and who is entrusted with the care and supervision of children, and/or persons engaged or involved in ministry who have regular individual contact with the elderly or disabled. When you submit this form, it will be sent to the appropriate person. A release page will be displayed that you can print out, sign, and send to the church office.
Last Name *
First Name *
Street Address *
Home Phone *
Place of Birth (City, State)
Emergency Contact Information
If you are Catholic, are you currently certified for Safe environment in your Parish? If not, you can skip the next question. if so, please select the correct entry in the next question and ask your Parish to send a letter of certification to the Safe Environment Manager.
Select the Parish that has certified you (background check and training).
ALL104 - All Saints Parish - Dallas
ALL108 - All Saints School - Dallas
ALL601 - All Saints Day Care - Dallas
AND107 - St. Andrew Kim Parish - Dallas
ANN049 - St. Ann Parish - Kaufman
ANN154 - St. Ann Parish - Coppell
ANT011 - St. Anthony Parish - Dallas
ANT068 - St. Anthony Parish - Wylie
AUG012 - St. Augustine Parish - Dallas
AUG217 - St. Augustine School - Dallas
BAS406 - St. Basil the Great Byzantine Catholic Church -
BER013 - St. Bernard of Clairvaux Parish - Dallas
BER219 - St. Bernard of Clairvaux School - Dallas
BLE001 - Blessed Sacrament Parish - Dallas
CAL032 - Calumet Community Center Inc. - Dallas
CAT010 - Cathedral Santuario de Guadalupe - Dallas
CAT077 - Catholic Charities - Dallas
CCGD74 - Christian Community of God's Delight - Dallas
CEC014 - St. Cecilia Parish - Dallas
CEC546 - St. Cecilia School - Dallas
CHA087 - Chancery Office - Dallas
CHA106 - Church of the Incarnation (UD) - Irving
CHD087 - Deacons - Dallas
CHI199 - Mission of Sacred Heart of Jesus - Plano
CHP087 - Priests - Dallas
CHR002 - Christ the King Parish - Dallas
CHR053 - Christ the King School - Dallas
COL336 - James L. Collins School - Corsicana
COR076 - Corpus Christi Parish - Ferris
CPL648 - Catholic Pro-Life Committee - Dallas
CUR080 - Cursillo Center - Dallas
DAL201 - Dallas Parochial League - Dallas
DIV056 - Divine Mercy of Our Lord Parish - Mesquite
DUN069 - Bishop Dunne Catholic School Inc - Dallas
EDW015 - St. Edward Parish - Dallas
ELI016 - St. Elizabeth of Hungary Parish - Dallas
ELI030 - St. Elizabeth Parish - Bonham
ELI103 - St. Elizabeth Ann Seton Parish - Plano
ELI237 - St. Elizabeth School - Dallas
EPI047 - Epiphany Mission - Waxahachie
FRA039 - St. Francis of Assisi Parish - Frisco
FRA051 - St. Francis of Assisi Parish - Lancaster
FRA152 - St. Francis Mission - Sherman
GAB071 - St. Gabriel the Archangel Parish - McKinney
GOO040 - Good Shepherd Parish - Garland
GOO259 - Good Shepherd School - Garland
HIG230 - Highlands School - Irving
HOL003 - Holy Cross Parish - Dallas
HOL004 - Holy Trinity Parish - Dallas
HOL045 - Holy Family of Nazareth Parish - Irving
HOL048 - Holy Family of Nazareth School - Irving
HOL082 - Holy Trinity Seminary - Irving
HOL097 - Holy Spirit Church Parish - Duncanville
HOL150 - Holy Family Mission - Van Alstyne
HOL249 - Holy Trinity School - Dallas
IMM034 - Immaculate Conception Parish - Corsicana
IMM042 - Immaculate Conception Parish - Grand Prairie
IMM189 - Immaculate Conception School - Grand Prairie
JAM017 - St. James Parish - Dallas
Jesuit - Jesuit Prep - Dallas
JOH037 - St. John Nepomucene Parish - Ennis
JOH041 - John Paul II High School Inc. - Plano
JOH064 - St. John the Apostle Parish - Terrell
JOH117 - St. John School - Ennis
JOS029 - St. Joseph Vietnamese Parish - Grand Prairie
JOS033 - St. Joseph Parish - Commerce
JOS067 - St. Joseph Parish - Waxahachie
JOS086 - St. Joseph's Residence Inc. - Dallas
JOS090 - St. Joseph School - Richardson
JOS105 - St. Joseph Parish - Richardson
JOS242 - St. Joseph School - Waxahachie
JUA212 - St. Juan Diego Parish - Dallas
JUD019 - St. Jude Chapel - Dallas
JUD186 - St. Jude Parish - Allen
KC799 - Knights Of Columbus - Dallas
LUK046 - St. Luke Parish - Irving
LUK220 - St. Luke School - Irving
LYN070 - Bishop Lynch High School Inc. - Dallas
MAR005 - Mary Immaculate Parish - Dallas
MAR020 - St. Mary of Carmel Parish - Dallas
MAR038 - St. Martin Parish - Forney
MAR057 - St. Mary of Carmel School - Dallas
MAR059 - St. Mark the Evangelist Parish - Plano
MAR062 - St. Mary Parish - Sherman
MAR099 - St. Mary's School - Sherman
MAR335 - Mary Immaculate School - Dallas
MAR545 - St. Mark Child Development - Plano
MAR547 - St. Mark Catholic School - Plano
MAR700 - St. Mary Malankara Parish - Garland
MATR10 - Matre Dei Church - Dallas
MIC054 - St. Michael Parish - McKinney
MIC111 - St. Michael the Archangel Parish - Garland
MIC153 - St. Michael the Archangel Parish - Grand Prairie
MON021 - St. Monica Parish - Dallas
MON548 - St. Monica School - Dallas
MOT265 - Mother of Perpetual Help Paris - Garland
MSM342 - Mount St. Michael Catholic School - Dallas
MSMCS1 - Mount St. Michael Catholic School - Dallas
NDS-TX - Notre Dame School -
NOT209 - Notre Dame of Dallas School - Dallas
NPBO - Non Parish Based Organization -
NUE075 - Nuestra Senora Del Pilar Paris - Dallas
OOD001 - Out Of Diocese - Dallas
OUR006 - Our Lady of Lebanon - Lewisville
OUR007 - Our Lady of Lourdes Parish - Dallas
OUR008 - Our Lady of Perpetual Help Parish - Dallas
OUR009 - Our Lady of San Juan-St. Theresa - Dallas
OUR088 - Our Lady of Angels Parish - Plano
OUR102 - Our Lady of the Lake Parish - Rockwall
OUR181 - Our Lady of Fatima Mission - Greenville
OUR216 - Our Lady of Perpetual Help Sch - Dallas
PAS381 - Pastoral Juvenil Hispana - Dallas
PAT022 - St. Patrick Parish - Dallas
PAT036 - St. Patrick Parish - Denison
PAT214 - St. Patrick School - Dallas
PAU060 - St. Paul the Apostle Parish - Richardson
PAU218 - St. Paul School - Richardson
PET023 - St. Peter the Apostle Parish - Dallas
PET256 - St. Peter Vietnamese Parish - Dallas
PHI024 - St. Philip the Apostle Parish - Dallas
PHI342 - St. Philip the Apostle School - Dallas
PHI343 - St. Philip the Apostle DayCare - Dallas
PIU025 - St. Pius X Parish - Dallas
PIU035 - St. Pius X Daycare - Dallas
PIU058 - St. Pius X School - Dallas
PRI160 - Prince of Peace Parish - Plano
PRI162 - Prince of Peace School - Plano
RED257 - Redemptoris Mater Seminary - Grand Prairie
RIT026 - St. Rita Parish - Dallas
RIT065 - St. Rita School - Dallas
SAC061 - Sacred Heart Parish - Rowlett
SAC063 - Sacred Heart of Jesus Parish - Carrollton
SAN028 - Santa Clara of Assisi Parish - Dallas
SAN031 - Santa Clara School - Dallas
SMU308 - SMU Campus Ministry - Dallas
SVDP09 - St. Vincent de Paul - Dallas
TEX081 - Texas Catholic - Dallas
THO027 - St. Thomas Aquinas Parish - Dallas
THO044 - St. Thomas Aquinas School - Dallas
THO346 - St.Thomas the Apostle Parish - Garland
TOBET1 - Theology of the Body Evangelization Team -
VIN410 - St. Vincent Center - Dallas
WEB999 - Webmaster - Dallas
WIL043 - St. William Parish - Greenville
List any skills, talents, education, training or experience that qualifies you for the position you are seeking, including professional license or certification:
List three personal references you have known three years or more. (not former employers or members of your immediate family)
At lease one phone number is required for each reference (Home, Cell or Work).
Street Address *
Street Address *
Street Address *
In the next field, list your City, State, County and dates of residence for the past five years
City, State, County, Dates
Because Notre Dame School cares for our children, youth and adults and desires to protect them, we ask you to please answer the following questions. We understand the following questions are personal and we will take all reasonable precautions to protect your privacy.
Are you presently abusing alcohol or using any illegal drugs?
Have you ever been convicted of, pleaded guilty or no contest to, placed on probation for, given probation, given community supervision, or given deferred adjudication for a crime or are you now under charges for any criminal offense?
Answering yes to these questions will not automatically exclude you for volunteering. The following lines are for any explanations or details that you would like to include for yes answers above.
Volunteer/Applicant Release Statement
· The information contained in this application is true and correct to the best of my knowledge.
· I understand that all criminal background checks will be treated as confidential.
· I understand and authorize the access to any and all information and records relating to my criminal history or criminal offenses committed or alleged, arrests, alleged criminal acts and criminal offenses committed.
· I understand and authorize any references, or any other person or organization, whether or not identified in this application, to give any information (including opinions) regarding my character and fitness for service.
· I hereby release any reference contact, whether identified or not in this application, and waive any and all claims, liability for damages of whatever kind or nature which may at any time result to me, my heirs/family, on account of compliance with this authorization, excepting only the communication of knowingly false information.
· I am aware that background checks may be updated periodically.
· If a disqualifying offense is found on a criminal background check, there is an appeal process in the Safe Environment Program. I understand that this process allows me to verify information and correct any errors.
· I intend this to be a legally binding release, which I have read and understand. I understand that I may consult with an attorney before signing this document. A facsimile or photocopy of this authorization shall be as valid as the original.
Date of Birth * Month
2 or 4 digit year
Social Security Number (Last 4 digits only)
Driver License Number *
(Enter your ID# if you do not have a DL.)
Driver License State *
Signature checkbox *
By clicking on the checkbox, I acknowledge that I have
CAREFULLY READ THIS RELEASE AND KNOW THE CONTENTS. I SIGN THIS RELEASE AS MY OWN FREE ACT.