FamilyCrisisCenter of Washtenaw 



Volunteer Application


Application Date_______________________________________________________________

Volunteer Position Sought________________________________________________________


Home Address__________________________________________________________________

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?

 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__



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.




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_____________________


City/State Zip____________________________________Telephone_______