Imperial Region Volunteer Application

Thank you for giving us the gift of your time and talent.

We can't wait to meet you and work together!

Basic Information
Address Line 1 *
Address Line 2
City *
State/Province *
Postal Code *
Home Phone:
Cell Phone:
Preferred contact method
Date of Birth:
Your Occupation:
Your Availability:

Emergency Contact
Emergency Contact Name:
Emergency Contact Phone:
Emergency Contact Relation:

Reference Name:
Reference Phone:
Reference Relation:

Other Information

Have you previously completed Safe Environment training and a background check for the Diocese of Lincoln?

Choose one:

Volunteer Positions: Check all areas of interest

Areas of interest
Areas of Interest Not Listed:

Restrictions, Service hour needs or requirement:

Use of Volunteer Photo, Video, and Voice Release Form

I give Catholic Social Services of Southern Nebraska (CSS), consent to record, videotape, photograph my image, and/or voice in relation to the mission of CSS. These items may be used in the following ways while volunteering at CSS:

  • Company Intranet accessible by employees only
  • Company Website accessible via the World Wide Web to anyone
  • Printed employee newsletter
  • Printed client/donor communications (i.e. Catholic Register Newspaper)
  • Company Print/Digital Marketing Materials
  • Printed annual report
  • Company social media platforms (i.e. Facebook, etc.)

I understand that no special compensation will be provided to me for the use of my image and that I may not be informed in advance of the specific use of my image. I further understand that I may opt-out of this practice upon providing written authorization to CSS.

Use of Volunteer Photo, Video, and Voice Release Form permission given:
Use of Volunteer Release Form approval:

Digital Signature: