Application

Support Staff Application

Applicants are considered without regard to race, color, sex, national origin, age, marital or veteran status, or the presence of a non-job-related medical condition or disability.
Full Name*

First NameMiddle NameLast Name
Home Address

Street Address

Street Address Line 2

CityState

Zip Code
Cell Phone*
Home Phone
Email Address*
example@example.com
Date of Birth

MonthDayYear
Social Security Number
EMERGENCY INFORMATION
Emergency Contact Name*
Emergency Contact Phone #*
Relationship to Emergency Contact*
POSITION INFORMATION
Position Applying for*

Office Support StaffVolunteerOther
How were you referred to The Peacemaker Center?
Why do you want to work at The Peacemaker Center?
VOLUNTEERS mark anticipated dates of Commitment

OnceWeeklyBi-WeeklyMonthlyOngoingUnsureSpecial projects only

All Applicants indicate times available

HIGH SCHOOL

	Name	Location - City & State	Year Graduated	Degree/Certification Earned
1
2
2

COLLEGE / UNIVERSITY

	Name	Location - City & State	Year Graduated	Degree/Certification Earned
1
2
3

POST GRADUATE / SPECIALIZED TRAINING

	Name	Location - City & State	Year Graduated	Degree/Certification Earned
1
2
3
4

Do you have volunteer or work experience in the field of counseling or other service-related fields?
List additional volunteer experience.
List recent employment experience.
List your interests, skills, and hobbies.
List any professional or civic organization to which you belong.
Describe your long-term career goals.
CRIMINAL HISTORY/CHILD ABUSE CLEARANCE
A Criminal History Clearance, or FBI Clearance for non-Pennsylvania residents and a Child Abuse Clearance is required as part of the application process. Do you have any objection?

NoYesOther
Were you ever convicted of a criminal offense (including driving under the influence (DUI) anywhere (any city, state, or locale)?

NoYesOther
Do you have a criminal charge against you now pending? (Omit minor traffic violations and anything prior to your 18th birthday). If yes, provide details and a copy of the docket. Convictions of a criminal offense will not necessarily prohibit you in all cases. Each case is considered on its own merits.
Have you ever had a Restraining Order issued against you? If yes, provide details.
Have you or any other adult living in your household had a Protection from Abuse order issued against them? If yes, provide details.
RESUME
Your Resume Can Be Uploaded Here

Cancelof
REFERENCES

Enter Four References - No Relatives Please

I authorize the references listed above to furnish The Peacemaker Center with any relevant information that may be required to arrive at a volunteer/employment decision. I hereby release The Peacemaker Center and the references listed from any liability arising from their receiving or giving information about my history, qualifications, or suitability for volunteering/working at The Peacemaker Center.
AGREEMENT
All Peacemaker Center staff, paid and unpaid, are required to sign an agreement regarding confidentiality. Your signature below indicates that you will agree to keep confidential all information learned regarding clients while performing your duties at The Peacemaker Center.

I certify that all information in this application is correct and complete, and I understand that any false statement or omission of material/fact may disqualify me from further consideration at The Peacemaker Center.
Signature*

Clear
Sign with your mouse, stylus, or finger
Date

MonthDayYear
Date
All information received on this application will be handled with the utmost care and confidentiality.
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Support Staff Application