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Diocesan Clearance Form

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  Clearance for New Employees and New Volunteers
  (Required whenever changing employers or supervising entities)
  
  Employee or Volunteer's Information
  
  Name of Employee or Volunteer
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address of Employee or Volunteer
  
  Street Address 1 REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address 2 Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Applicant is seeking clearance for employment or volunteer work? REQUIRED Please fill out this field.
  
  Where will the individual be employed or volunteer? REQUIRED Please fill out this field.
  
  Your Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Your Title REQUIRED Please fill out this field. Please enter valid data.
  
  Organization submitting this request REQUIRED Please fill out this field. Please enter valid data.
  
  Today's Date REQUIRED Please fill out this field. Please enter a date.
  
  Email for receiving response from Office for the Protection of Children & Youth REQUIRED Please fill out this field. Please enter an email address.
  
  Postal Address to receive a hard copy (Parish/School/Organization)
  
  Name of Parish/School/Organization REQUIRED Please fill out this field. Please enter valid data.
  
  Street 1 REQUIRED Please fill out this field. Please enter valid data.
  
  Street 2 Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Submit
  
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Diocesan Clearance Form

Clearance for New Employees and New Volunteers

(Required whenever changing employers or supervising entities)

Employee or Volunteer's Information

Your Information

Postal Address to receive a hard copy (Parish/School/Organization)

Diocesan Pastoral Center

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