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FamilyCrisisCenter of Washtenaw 

734-660-7059

FAMILY CRISIS CENTER VOLUNTEERING
Family Crisis Center of Washtenaw welcomes your support through our volunteer program. Many of us want to give back to our community. Volunteers bring unity to our community through offering their time and effort to assist us in empowering and promoting healthy lifestyles for families and individuals experiencing a life crisis. Each volunteer has something special they can offer to make a difference. Please contact us at 734-660-7059 or print and fill in our volunteer application below and drop or mail to us at:                   2385 Huron Pkwy. Ste.2N, Ann Arbor, MI 48104


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_______