Written Reference

Applicants Full Name: Click or tap here to enter text. has applied to serve as a volunteer at St. Lawrence Martyr Catholic Church. The Archdiocese of Baltimore and St. Lawrence Martyr Catholic Church have a strong commitment to supporting healthy ministry to children and youth. For this reason, it is our policy to ask certain questions of all applicants for employment and volunteer work, and of the people whose names are provided as reference. Please check the appropriate response to the following questions.

To your knowledge, has the applicant ever been accused of, charged with, or convicted of child abuse? ☐ Yes ☐ No

To your knowledge, has the applicant ever been terminated from any volunteer service or employment due to suspected child abuse? ☐ Yes ☐ No

Are you aware of any reason why the applicant should not be placed in a position where he/she will be working with children and youth? ☐ Yes ☐ No

To your knowledge, is there any reason why applicant should not serve as a volunteer at St. Lawrence Martyr Church. ☐ Yes ☐ No

If yes, please explain. Click or tap here to enter text.

This reference must be signed and dated.

Your Full Name: Click or tap here to enter text.

Your Relation to Volunteer: Click or tap here to enter text.

Years Known: Click or tap here to enter text.

Signature ______________________________________________ Date: Select Date

Please Print and return form to: St. Lawrence Martyr Catholic Church

Attn: Stand Coordinator

Please use address below