Mr    Mrs    Ms

Name:  
 
First     Middle      Last

Address:   

Street

City             State         Zip

Phone Number:   
 
Home         Work      Cell

Email

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:         Telephone Number:   

Check one: Employed     Unemployed    Self-Employed    Retired

If employed, 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?   

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

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

Name                                        Address                                                                        Phone No.

How did you hear about the Victim Assistance 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 work.

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 socioeconomic backgrounds.  Sometimes clients may have values or beliefs quite different from your own.  Please describe why this will or will not present a difficulty or adjustment for you as a service provider.

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

 
(Note - only click Submit once - if you get a FrontPage Error your form was still sent)
We are working on this problem