FAMILY CRISIS CENTER VOLUNTEERING
Volunteer Position Sought________________________________________________________
Home Phone___________________________ Work Phone______________________________
Male______ Female Date of Birth____________
Highest level completed__________________________________________________________
Current Employer, if applicable
Dates of Employment (starting, ending) ____________________________________________
Would you like us to keep employer abreast of your volunteer service and achievement?
Skills & Experience
Special training. Skills, hobbies
Groups, clubs, organizational memberships (please describe your prior volunteer experience, include organization name and dates of service) ___________________________________________________
What experiences have you had that may prepare you to work as a volunteer in the field of (description of field e.g. domestic violence, child abuse prevention, youth recreation, etc.)?
Why do you want to volunteer? (Or, what do you want to gain from this volunteer experience? ______________________________________________________________________________
Have you ever been convicted of a crime? If yes, please explain the nature of the crime and the date of the conviction and disposition. Conviction of a crime is not an automatic disqualification for volunteer work.
Do you have a driver’s license? Yes___ No___ Do you have car insurance? Yes ____ No____
Do you have a car available for transporting others? Yes__ No__
Please list three people who know you well and can attest to your character, skills and dependability. Include your current or last employer.
Relationship to you
Length of relationship
Please read the following carefully before signing the application:
I understand this is an application for and not a commitment or promise of volunteer opportunity .I certify that I have and will provide information throughout the selection process, including on this application for a volunteer position and in interviews with FCC of Washtenaw that is true, correct, and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that information contained on my application will be verified by FCC of Washtenaw. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with FCC of Washtenaw or my termination as a volunteer.
Volunteer Availability (circle all applicable)
Number of days per week 1 2 3 4 5
Monday Tuesday Wednesday Thursday Friday No Preference
In an emergency, notify First Name ___________________Last Name_____________________