Name |
|
| Email |
|
| Maiden Name/Aliases |
Date of Birth
|
|
|
|
| Address |
|
| City |
State
Zip
|
|
|
|
| Home Phone |
|
| Work Phone |
|
| Cell Phone |
|
Are you currently
employed?
Yes
No
|
| If so, where? |
|
| Position or Title |
|
Is the position full
or part time?
|
What is your educational background?
|
Primary Language |
|
| Secondary Language |
|
| Race |
|
| Marital Status |
|
| Spouse's Name |
|
| Spouse's Employment |
|
| Spouse's Position/Title |
|
Child(ren)'s names and ages
|
Present volunteer activities
|
Previous volunteer experiences
|
Affiliations (service clubs, sororities/fraternities,
etc.)
|
Do you have any medical limitations
or afflictions which may affect
your ability to fulfill your volunteer responsibilites?
|
Are there any special needs that
a child may have with whom you
would be uncomfortable working?
|
Have you had any personal
experience involving the following?
If so, please explain below.
a)
Child Welfare or Child Protective
Services
b)
Juvenile Court
c)
Foster Care
d)
Any agencies dealing with
juveniles |
Comments/explanations to answers
a, b, c, d above
|
Skills and Interests
|
How did you become aware of Child
Advocates, Inc.?
|
Write a brief statement indicating
why you would like to be a
volunteer for Child Advocates, Inc.
|
Please list three local (non-relative)
references.
(name, address, and day time phone number)
|
Tell us about your family from
the time you were a child to the
present (i.e. how many siblings do you have, what
was it like
growing up in your household, how did you get to
where you
are today).
|
What is your most positive personal
attribute?
|
What is your most negative personal
attribute?
|
On a scale of 1 to 5, 1 being
poor and 5 being excellent, evaluate
yourself on the following: |
| Emotional Maturity..................... |
|
| Self Confidence.......................... |
|
| Self Motivation........................... |
|
| Open Mindedness....................... |
|
| Appearance................................. |
|
| Ability to work with others........... |
|
| Ability to accept supervision......... |
|
|
What experiences/skills do you
possess that might enhance your
volunteer work with Child Advocates?
|
Do you feel you have realistic
expectations of your role as a
Volunteer with our agency?
|
What do you see as your most difficult
task as a Volunteer with
Child Advocates?
|
Have you ever been arrested?
Yes
No
If yes, please explain
|
Have you ever been convicted of
a felony/misdeameanor?
Yes
No
If yes, please explain
|
I understand that as a volunteer
for Child Advocates, Inc., I will work
directly with the Marion County Office of Family
and Children and the
Marion County Juvenile Court.
Yes
I understand that Child Advocates, Inc. will contact
my references
and run a criminal record check on me and I hereby
give my consent.
Yes
Your social security number will be requested
at the orientation
session you will attend prior to volunteer training.
If accepted as a volunteer, I will agree to abide
by all policies and
directives of the court, to maintain confidentiality,
and submit reports
as required.
Yes
I hereby swear and affirm that I have never been
convicted of any
charges involving crimes against children - including
physical or sexual
abuse or a history of physical or sexual abuse
of children in Indiana or any other state.
Yes
Your volunteer form may
be submitted to us below. Please make sure
your information has been filled out as completely
as possible.
Thank you!
Enter the code above here:
If you can't read the code above, request another. Request
new code >>
|
