39-41 rue Olivier de Serres
75015 Paris
Tél:+33(0)1 42 50 06 48
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Application form

Personal details:

First name:	Surname:
	Marital name:

Date of birth:

Place of birth:

   Gender:   M F

   Nationality:

   Family status:   Marital status    Single    Other

   National service obligations:   Yes    No

   Address- first line:

Postal code:

Town:

Country:

Telephone - home:

Telephone - mobile:

email address:

Training, qualifications, skills and experience:

   Diploma(s) obtained or level of training completed (give time and place of training):


   Current or planned career or profession:


   Experience to date with people with learning disabilities:   Yes    No

If yes please give details:

Hobbies and interests:

Driving licence: Yes No

Number of years with driving licence:

Mother tongue:

Other languages spoken:

Level of French:

Contacts in l'Arche:

   Please, give details for your desired involvement:
   Volunteer    Employee    Volunteer (assistant in a house)

   Observations :


   Prior knowledge of a community of l'Arche?:   Yes    No

If so, which community?

as a ...:

paid worker volunteer occasional visitor

for how long?

   How did you hear about l'Arche in Paris?


   What do you hope to gain from an experience in l'Arche?


   What motivates you to build relationships and work with
   people with learning disabilities?


   Why l'Arche in Paris?

Have you applied for another community in l'Arche?

Yes No

When would you be available to begin?

How long would you wish to commit yourself for?

References:

Please give the details of at least one person we can contact with regards to your application. This person, who cannot be a member of your family, will have known you during your studies or in a professional capacity, or through voluntary work or time spent in a community.

   Title, first name and surname:


   Postal address:


   Email address:

   Telephone (daytime):

   Telephone (evening):

   How long has this person known you?

   In what capacity?


To obtain volunteer status, you must be free of criminal record.

You must have up to date vaccinations against diseases such as diptheria, tetanus and polio.

Thank you for completing this form and for forwarding your CV to: contact@archeaparis.org.

Legislation governing information technology

Your details will be protected by current data protection legislation. The information you have provided will be sent to l'Arche in Paris. However they may also be sent to a third party (for example other communities of l'Arche, the Federation of l'Arche in France and others).

   I give permission for my details to be shared
   Yes   No