RDVCC
E-mail Address: *
Name: *
Telephone: *
Address: *
Date Of Birth: *
What Type Of Involvement Are You Interested In? *
Crisis Line
Hospital Advocacy
Shelter Advocacy & Transportation
Court Advocacy
Outreach
Office
Time Availability: *
days (7a-7p)
evenings (7p-7a)
weekends
Education: *
Special Skills/ Interests:
Experience with Crisis Situations: *
Reason for interest in volunteering with the Crisis Center: *
Have you ever been reprimanded, disciplined in any way or dismissed as an employee or volunteer because of: *
Sexual Misconduct
Violent Conduct
None
If Yes. Please Describe:
Have you ever had a temporary or final domestic violence protective order against you? *
Yes
No
If Yes. Please Explain and put dates from ____ to ____
Have you ever been convicted of any crime: *
Yes
No
If Yes. Please explain:
Do you have a problem with drugs and/or alcohol: *
Current Employer: (Name and Number) *
Previous Employer: (Name and Number) *
All Organizations For Which You Have Previously Volunteered:
Please list 3 personal references that you have known for at least 2 years and that are not related to you: (Name and DAYTIME phone number) *
I authorize the people and employees and officers of the places I have mentioned above to provide The Rape and Domestic Violence Crisis Center any information requested by the Center that may be required to arrive at a decision about my application to work as a volunteer. *
Date of Application: *
Online Signature: *
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