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.
Home PhoneWork PhoneCell PhoneEmail
YesNo
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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.
High SchoolProfessional / TechnicalCollegeGraduate School
YesNo
Reference (non-related) Name, Address, Phone Number
How did you hear about Victim Service Program?
YesNo
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.

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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