CALLUSNOW

FamilyCrisisCenter of Washtenaw 

734-660-7059

FAMILY CRISIS CENTER OF WASHTENAW


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_____________________

Addres________________________________________________________________________

City/State Zip____________________________________Telephone_______