Rocky Creek / Discovery Trail Internship Application [040416]

CONTACT INFORMATION

Today's Date

Name

First NameLast Name

Preferred Gender Pronouns

Other

Phone

E-mail Address

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

ELIGIBILITY INFORMATION

Date of Birth

Volunteers must be at least 18 years of age

Do you have reliable transportation?

Do you have an active driver's license and car insurance?

Do you have access to a personal phone?

Have you ever been a client with SVRCBG?

When were you a client?

Why are you interested in volunteering at SVRCBG?

VOLUNTEER REQUIREMENTS

Which type of volunteering are you interested in?

Volunteers must go through our 40-hour training before becoming an advocate. Are you willing and able to complete this training?

Shifts available to volunteers are afterhours and on weekends. Are you available to volunteer during those times?

We ask that volunteers sign up for at least 4 shifts per month. How many shifts do you plan to sign up for each month?

As a volunteer, you will be required to attend at least one meeting per quarter and complete 8 hours of continuing education each year. Are you willing and able to meet this requirement?

How did you find out about our volunteer opportunity?

REFERENCES

Please list three references (other than relatives or SVRCBG staff) that we may contact. One MUST be a professional reference (e.g. Supervisor, Professor, etc.).

Reference 1

First NameLast Name

Email

example@example.com

Relation

Reference 2

First NameLast Name

Email

example@example.com

Relation

Reference 3

First NameLast Name

Email

example@example.com

Relation

BACKGROUND CHECKS

SVRCBG is required by the Kentucky Administrative Statutes on Rape Crisis Centers to run a background check on all staff and volunteers. Offenses that may disqualify an applicant include violent offenses and offenses against children.

Have you ever been convicted, imprisoned or fined for a felony?

If yes, please explain. Give dates and locations.

Upload Your Resume Here

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CERTIFICATION OF APPLICANT

I certify that all answers to the questions in this application are true and I further understand that any false statement in this application will be sufficient grounds of rejection of the application or termination of employment/volunteer status without notice at any time hereafter. I authorize the Sexual Violence Resource Center of the Bluegrass to complete a criminal background check if I have applied to a position subject to this requirement. I understand that the findings of a record check may be grounds for rejection of application or termination of employment/volunteer status without notice. I authorize the Sexual Violence Resource Center of the Bluegrass to make all necessary investigations to verifying information contained herein, and authorize and release from liability and and all references to provide information relevant to my application for employment or volunteering.

I certify that my electronic signature is the equivalent of my manual signature on this document.

Name of Applicant

Date

(MM/DD/YYYY)

Thank you for your interest in volutneering with us. We will be in touch shortly. If you have any questions, please don't hesitate to contact Angela Hampton at: AHampton@SVRCkentucky.org

Volunteer Application