Mr.  Mrs.  Ms.

Name:     First   Middle   Last 

Street Address:  

City, State, Zip:  

Home Phone:    Cell Phone:    Work Phone: 

Email Address: 

Date of Birth:      (Note - you must be 21 or older)

Driver's License Number: 

Do you have your own transportation?  Yes   No

In case of emergency, notify:    Phone: 

Check one:  Employed  Unemployed  Self-employed  Retired

Place of employment: 

Title/Duties:         Number of Years Employed: 

Supervisor:  

Regular working hours: 

Previous Employer: 

Reason for leaving:  

Volunteer Experience (Where and activities performed): 

Education:  High School  Professional/Technical  College  Graduate School

Have you ever been convicted of a crime?  Yes  No

If yes, state nature of offense, when and where occurred: 

REFERENCES: List three (3) references not related to you:

Name:                                                                     Address:                                                                Phone Number

How did you hear about Victim Service Program?  

Are you able to commit yourself to being on-call on a given day per-week?  Yes  No

If No, please explain your limitations and length of time/commitment that you are able to make:

Will you be able to attend in-service training sessions at the Sheriff's Office, in addition to your regularly scheduled volunteer time?
Yes  No

VOLUNTEER TIME PREFERRED:

Every effort is made to accommodate the preference of applicants.. However, the size of the Victim Service Unit necessitates scheduling volunteer assignments over the course of the work-week.  Below, please check each time(s), and day(s), you would be able to volunteer.

Mon  Tues  Wed  Thurs  Fri  Sat  Sun

Holidays  Days  Afternoons  Evenings

Why would you like to work with the Victim Service Unit? 

What additional skills and strengths would you like to develop as an outcome of your experience with this program?

As a volunteer you will be working with clients of many different ethnic and social-economic backgrounds.  Sometimes clients may have values or beliefs quite different from your own.  Please describe why this will or will no present a difficulty or adjustment to you as a service provider.

Click the Submit Button to send.
By clicking the submit button you are agreeing to a background check with the Sheriff Department.