Volunteer Recruitment Form

Name *

First Name Last Name

Date of Birth *

Date

E-mail *

Phone Number *

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Social Security Number

Driver's License Number

Driver's License State

Place of Employment *

Position/Title *

Level Of Education *

GED High School Associates Bachelors Masters Doctoral

Graduation Year *

Degree/Major *

Are you currently enrolled in school? *

Yes No

Are you enrolled in school Part Time or Full Time? *

Part Time Student Full Time Student

What school are you attending? *

What degree or major are you pursuing? *

Anticipated Graduation Date *

Are you bilingual? *

No Yes

Which language/degree of fluency? *

Do you have reliable transportation? *

Yes No

Marital Status?

Single Married Divorced Widowed Seperated

Spouses Name

Spouses Place of Employment

List any children (Names & Ages)

Put N/A if not applicable.

Do you have experience working with children? *

No Yes

Please Explain *

Have you ever applied to another organization that works with children? *

No Yes

Were you accepted? *

Yes No

Name of Organization *

Please describe your role and your responsibilities *

Please list other volunteer experiences. *

Have you ever worked with any other Children's Advocacy Center? *

No Yes

If you've worked at any other Children's Advocacy Center, please list where, when, and in what capacity. *

Please list any present memberships, clubs, or organizations (include offices held). *

Please complete all questions. *

	Yes	No
Are you now, or have you received counseling?
Have you ever been hospitalized for an emotional problem?
Have you ever been charged and/or convicted of a misdemeanor?
Have you ever been charged and/or convicted of a felony?
Have you ever been or are you currently on probation and/or parole?
Have you ever had your license suspended or revoked?
Do you or have you ever had a chemical and/or alcohol dependency/abuse problem?
Are you now or have you ever had treatment for alcohol dependency/abuse problem?
Do you have any kind of health impairment?
Have you or do you now engage in sexual misconduct which, if known, could cause harm to a child, you or the CAC?
Have you ever been charged or convicted of sexual misconduct (including pornography)?
Have you or any member of your family been involved in a case that was heard in the Bell, Coryell, or Milam County District Courts?

If you answered "yes" to any of the previous questions please provide details. *

Please Provide three references (name, relationship, address & phone). *

Why do you want to become a CACCT volunteer? *

Which days of the week do you want to work?

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Enter a range of work hours per week

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If you would like to submit a resume, please do so here.

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The Undersigned Acknowledges and Agrees That:

1) They are not obligated, if called upon, to accept responsibilities as requested by the Children's Advocacy Center of Central Texas.

2) Nor is the Children's Advocacy Center of Central Texas obligated to assign or request volunteer duties from the applicant.

3) As part of the Children's Advocacy Center of Central Texas's policy, additional personal information may be obtained during the interview process.

4) The Children's Advocacy Center of Central Texas has the right to refuse any individual that it feels would not be in the best interest of the program and further, the center is not required to state the reasons(s) for non-acceptance.

5) The volunteer's file is held in the strictest confidence and becomes the property of the Children's Advocacy Center of Central Texas.

I give my permission to the Children's Advocacy Center of Central Texas to release information about my experience as a volunteer and to any other Children's Advocacy Center program to which I may apply in the future.

I have truthfully responded to all of the questions on this application:

Signature *

Clear

Date *

Date

The Children’s Advocacy Center of Central Texas is an equal opportunity employer. All employees will be recruited, hired, trained, assigned, and promoted in all positions without regard to race, color, sex, age, religion, national origin, or disability. Each employee has an equal opportunity to make a maximum contribution to their job, to themselves, and our community.

Volunteer Application