CSVA Volunteer Application

CSVA Volunteer Application

Apply to become a volunteer advocate. Please complete all sections and provide accurate information.
Name - Last
Name - First
Address - Street
Address - Town/City
Address - State
Address - Zip
Phone (home)
Please enter a valid phone number.Format: (000) 000-0000.
Phone (work)
Please enter a valid phone number.Format: (000) 000-0000.
Phone (cell)
Please enter a valid phone number.Format: (000) 000-0000.
E-mail
example@example.com
Other contact info
Employer’s Name
Employer’s Address
Your Occupation
Are you at least 18 years old?
Have you ever been convicted of a crime involving child abuse, neglect, or endangerment, domestic violence, sexual violence and/or physical assault?
If yes, please explain and give dates
Educational Training/Background
Do you speak a language other than English?
If yes, please list languages
Do you have a valid driver’s license?
Prior and/or Current Volunteer Experience
Why do you want to volunteer as a confidential sexual violence advocate? (for CSVA applicants only)
What is your knowledge or experience with sexual violence? (for CSVA applicants only)
Are you committed to attending all training sessions, which serve as a legal requirement and a responsibility to provide best services to survivors?
Do you have the availability to dedicate yourself to consistent and reliable shifts every month? (For at least 1 year)
Are you able to make a time commitment that includes weekends and overnight hours?
Are you able to serve based on schedule and transportation needs (e.g. valid license, access to vehicle, flexibility on nights and weekends, etc.)? (for CSVA applicants only)
Do you consent to a criminal background check?
Is there any incidents and/or concerns you think is necessary to inform us of?
Reference 1 - Name
Reference 1 - Address
Reference 1 - Phone Number(s)
Please enter a valid phone number.Format: (000) 000-0000.
Reference 1 - Relationship
Reference 2 - Name
Reference 2 - Address
Reference 2 - Phone Number(s)
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2 - Relationship
Reference 3 - Name
Reference 3 - Address
Reference 3 - Phone Number(s)
Please enter a valid phone number.Format: (000) 000-0000.
Reference 3 - Relationship
Applicant Signature
Date

MonthDayYear
Date
Should be Empty: