Sheriff Victim Services Unit Application

Victim Services Unit Application

Name*

PrefixFirst NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Method of Contact

Home PhoneWork PhoneCell PhoneEmail
Do you have reliable transportation?*

YesNo
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employment Status

EmployedRetiredSelf-EmployedUnemployed
Place of Employment
Title/Duties
Number of Years Employed
Supervisor Name

First NameLast Name
Regular Working Hours
Previous Employer
Reasons for Leaving
Volunteer Experience
Where and activities performed.
Education

High SchoolProfessional / TechnicalCollegeGraduate School
Have you ever been convicted of a crime?

YesNo
Reference (non-related) Name, Address, Phone Number
How did you hear about Victim Service Program?
Are you able to commit yourself to being on-call on a given day per-week?*

YesNo
Will you be able to attend in-service training sessions at the Sheriff's Office, in addition to your regularly scheduled volunteer time?*

YesNo

Every effort is made to accommodate the preference of applicants. However, the size of the Victim Service Unit necessitates scheduling volunteer assignments over the course of the work-week. Please check each time(s), and day(s), you would be able to volunteer.*

Rows	Mornings	Afternoons	Evenings
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Holidays? *
List Holidays you are available.
Why would you like to work with the Victim Service Unit?*
What additional skills and strengths would you like to develop as an outcome of your experience with this program?*
As a volunteer you will be working with clients of many different ethnic and social-economic backgrounds. Sometimes clients may have values or beliefs quite different from your own. Please describe why this will or will no present a difficulty or adjustment to you as a service provider.*
By clicking the submit button you are agreeing to a background check with the Sheriff Department.

Would you to receive an email copy of this form?

YesNo
Email to Receive a Copy
This field is not a part of the form Submission
Please verify that you are human*
Signature
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