VOLUNTEER APPLICATION
Personal Information
Name
Home Phone
Address
Work Phone
City
State
Zip
E-mail
Employer Name/Occupation
Employer Address
Social Security Number
Date of Birth
Sex
Female
Male
Race
Marital Status
Single
Married
Separated
Divorced
Widowed
No. of children
Educational History
High School Graduate?
Yes
No
GED?
Yes
No
Name of College
Highest Degree
Other
Volunteer History
How did you become aware of DVVAP?
Have you ever volunteered for a domestic violence program?
Yes
No
If yes, where?
Please discuss why you want to become a volunteer.
List special skill (knowledge) and strengths you will bring to this program.
Do you have a police record?
No
Yes
If yes, date and type of offense.
Have you ever been accused of child abuse and/or neglect?
No
Yes
IN CASE OF EMERGENCY, WHO SHOULD BE NOTIFIED?
Name
Relationship
Phone numbers
Social Services Experience
Briefly describe any past or present experience (personal or professional) with any of the following agencies:
Department of Social Services
Court System
Legal Services
Shelters
Hospitals
Please complete the following 3 questions ONLY if you are applying for advocacy opportunities:
1. Will your schedule permit you to be on call for up to 3 hours at a time?
Yes
No
2. Will you be willing to travel on short notice to "SAFE PLACES", such as police stations and hospitals to work with victims?
Yes
No
3. Can you commit to working two shifts each month for a year?
Yes
No
Personal References
Please list three personal references.
At least one reference must be someone other than a friend or co-worker, e.g. Employer, etc.
1.
Name
Relationship
Phone
Address
City/State
ZIP
2.
Name
Relationship
Phone
Address
City/State
ZIP
3.
Name
Relationship
Phone
Address
City/State
ZIP
I UNDERSTAND THE SENSITIVE NATURE OF THE WORK OF THE DOMESTIC VIOLENCE VICTIM ASSISTANCE PROGRAM AND, THEREFORE, GIVE MY CONSENT FOR A BACKGROUND CHECK TO BE COMPLETED AND THE ABOVE REFERENCES TO BE CONTACTED.
Signature of Applicant:
Date:
(Entering your name here constitutes a legal signature.)
Please check your responses. When you click the submit button, an email with this application will be sent to DVVAP and a copy will be sent to you. If you do not receive a copy, you may have entered your email address incorrectly. In that case, please call DVVAP to verify they received it.