Volunteer Application

Name

Date

Address

Phone: (home)

Format: (000) 000-0000.

Phone: (cell)

Format: (000) 000-0000.

Phone: (work)

Format: (000) 000-0000.

Email

example@example.com

How did you hear about us?

List all schools attended. Include name of school, location, dates attended "from - to", course pursued,

date graduated, degrees or diplomas.

List all schools attended. Include name of school, location, dates attended "from to", course pursued, date graduated, degrees or diplomas.

Employer

Job Title

Address

Phone

Format: (000) 000-0000.

Dates of employment

Date

Job Title

Employer

Address

Phone

Format: (000) 000-0000.

Dates of employment

Date

Employer

Job Title

Address

Phone

Format: (000) 000-0000.

Dates of employment

Date

Please list all volunteer all volunteer experience you have had

Have you ever received the state-required 40 hour training for domestic violence and/or sexual assault? (this training is not required for all volunteer opportunities

Yes

No

If yes, when and where did you complete this training?

Give three (3) references who are not relatives. Preferably these are people who have known

Name

Phone

Format: (000) 000-0000.

Address

Relationship

Length of time known

Name

Phone

Format: (000) 000-0000.

Address

Relationship

Length of time known

Name

Phone

Format: (000) 000-0000.

Address

Relationship

Length of time known

When are you available to start volunteering?

If you work, please list the days and times you will not be available to volunteer because of that

If you work, please list the days and times you will not be available to volunteer because of that obligation

Please check all volunteer opportunities for which you are interested in applying. Those listed with an asterisk (*) do not require the 40 hour domestic violence or sexual assault training. Domestic Violence Response Team (DVRT)

Sexual Assault Response Team (SART)

Court accompaniment

Clerical

Translators for Spanish speaking clients

Fundraising Committee

Other (please specify)

NO

If "yes", please explain

Have you ever been arrested, charged, or summoned with any offense including but not limited to Domestic Violence, disorderly persons offenses, (i.e., public intoxication, D.U.I, Township

NO

If "yes", please explain

Do you have any prior involvement or experience with Domestic Violence or Sexual Assault,

either as a victim or an accused? YES

YES

NO

If "yes", please explain

Do you know personally, anyone who has been the victim or defendant in any Domestic

Violence or Sexual Assault matter? YES

YES

NO

If "yes" please explain using general information (do not use victim or defendant names).

NO

If "yes", please explain

For those applying to be advocates on the Domestic Violence Response Team (DVRT) or the Sexual Assault Response Team (SART), please answer the following questions: How did you hear about the Domestic Violence Response Team (DVRT) or the Sexual Assault Response Team (SART)?

How did you hear about the Domestic Violence Response Team (DVRT) or the Sexual Assault Response Team (SART)?

What, if any, has been your experience in domestic violence or sexual assault?

What special skills, interests, or experience do you have which would contribute to your involvement in domestic violence or sexual assault support and services?

Explain your reasons for applying to be an advocate on the Domestic Violence Response Team (DVRT) or the Sexual Assault Response Team (SART).

How do you feel about working in an environment that deals with sensitive issues such as incest, reproductive choice, sexual orientation, domestic violence, and rape?

Volunteering as an advocate involves time and energy. Are you willing to commit to on-call shifts, attending quarterly meetings, and occasional associated events?

Yes

No

I understand that my service as a Domestic Violence Response Team (DVRT) or Sexual Assault

Response Team (SART) advocate will be contingent upon the results of processing this

application. I am aware that willfully withholding information or making false statements on

this application will be the basis for dismissal from Domestic Violence Response Team (DVRT) or

Sexual Assault Response Team (SART I agree to these conditions and I hereby certify that all

statements made by me on this application are true and complete, to the best of my

Signature of Applicant

Date

Thank you for your interest in becoming a volunteer for SCWS. Please return all portions of this application to SCWS, PO Box 125, Salem, NJ 08079 or by fax (856)935-6165.

Sincerely, Cherronna Minor

(Name)

,

Format: (000) 000-0000.

(Address)

permission for Salem County Women's Services to request a criminal background check from Identogo by Morpho Trust.

Signature

Date