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Name
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Driver's License #:
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Driver's License State:
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Social Security Number:
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Have you ever been convicted of a crime?
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YES
NO
If you answered YES, please explain:
Volunteer Experience:
ORGANIZATION NAME:
First Name
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ORGANIZATION ADDRESS:
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End Date
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Supervisor Name
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Employment Experience:
Organization Name:
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First Name
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End Date:
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Supervisor Name:
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Supervisor Phone #:
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Please enter a valid phone number.
Duties Performed:
Organization Name:
Address
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Street Address Line 2
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State / Province
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Start Date:
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Date
End Date:
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Date
Organization
Supervisor Name
First Name
Last Name
Supervisor Phone #:
Please enter a valid phone number.
Duties Performed:
Organization Name:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Start Date:
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Month
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Day
Year
Date
End Date:
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Month
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Day
Year
Date
Supervisor Name:
First Name
Last Name
Supervisor Phone #:
Please enter a valid phone number.
Duties Performed:
Additional Information:
What are your reasons for wanting to volunteer with Five14 Revolution?
Do You consider yourself a Christian?
YES
NO
As a Christian, what is the basis of your salvation?
If you attend Church, please list here:
Church Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Positions in which you have served IF APPLICABLE:
Please briefly state how your faith would affect your volunteer work with this organization:
What special skills, talents, gifts, or personality traits would you bring as a Five14 Volunteer?
Please list any books, material, or knowledge that you have in relation to human trafficking, sex trafficking, or labor trafficking:
How would you rate your knowledge of the signs to look for concerning victims of human trafficking?
Excellent
Good
Fair
Poor
How would you rate your knowledge of current laws surrounding human trafficking?
Excellent
Good
Fair
Poor
How would you rate your comfort working with survivors who have been mentally, physically, and emotionally abused?
Excellent
Good
Fair
Poor
Have you ever been treated for a psychiatric disorder?
*
Yes
No
If yes, please explain:
Have you ever been concerned that you may have an addiction to drugs, alcohol, pornography, or any other addiction; or has anyone ever suggested that you may have a problem with any of the above?
*
Yes
No
If yes, please explain:
Have you ever been convicted of the possession, use, or sale of drugs within the last 10 years?
*
Yes
No
If yes, please explain:
Has your driver's license been suspended or revoked within the last 12 months?
Yes
No
If yes, please explain:
What do you consider to be your areas of weakness?
How would you resolve conflict while working with others who have different personality traits or views than yours?
References:
Church Member, Mentor, or 514 Staff Member:
First Name
Last Name
Relationship:
Length of time known:
Phone Number:
Please enter a valid phone number.
Friend or Neighbor:
First Name
Last Name
Relationship:
Length of time known:
Phone Number:
Please enter a valid phone number.
Employer or Co-worker:
First Name
Last Name
Relationship:
Length of time known:
Phone Number:
Please enter a valid phone number.
Please list any specific medical concerns of medication we should know about in case of emergency:
Please list any known allergies:
Your Availability and Position of Interest:
Position of Interest:
I would like to serve on (Please Fill in the Day)
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I would like to serve on (Please Fill in the Day)
Start Time (AM)
End Time (PM)
I would like to serve on (Please Fill in the Day)
Start Time (AM)
End Time (PM)
*I give Five14 Revolution to conduct a criminal background check to the extent that my volunteer duties may involve direct interaction with minors*
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