Family Crisis Center forms

FAMILY CRISIS CENTER VOLUNTEERING

Volunteer Application

Application Date_______________________________________________________________

Volunteer Position Sought________________________________________________________

Name_________________________________________________________________________

Home Address__________________________________________________________________

Home Phone___________________________ Work Phone______________________________

Email_________________________________________________________________________

Male______ Female Date of Birth____________

Education

Highest level completed__________________________________________________________

Employment

Current Employer, if applicable

Position/Title__________________________________________________________________

Dates of Employment (starting, ending) ____________________________________________

Company/Employer_____________________________________________________________

Address_______________________________________________________________________

Would you like us to keep employer abreast of your volunteer service and achievement?

No___ Yes____

Languages

Fluent

Read

Write

_______________________________________________________________________________________

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__

References

Please list three people who know you well and can attest to your character, skills and dependability. Include your current or last employer.

Name/organization

Relationship to you

Length of relationship

Phone number

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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.

Signature___________________________________________Date_______________________

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_____________________

Address________________________________________________________________________

City/State Zip____________________________________Telephone____________