Volunteer

First Name

Last Name

Date of Birth

Mailing Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Email Address *

Confirm Email Address *

Home Phone

Office/Cell Phone *

Occupation

Supervisor's Name

Place of Employment/Address

Do you drive?YesNo

Do you have use of a car?YesNo

Do you speak any foreign languages?

Educational Background

Volunteer/Professional Activities

How did you hear about our program?

Why do you want to volunteer with us?

What are your strongest points in working with Domestic Violence victims?

What do you feel would be the most difficult part?

What training would you need beforehand?

Have you ever held a role that required strong communication skills?YesNo

If you answered Yes: Describe the role

Have you ever been close to someone who was raped?YesNo

Code of Conduct

I WILL NOT USE MY POSITION FOR A PUPOSE THAT CONTITUTES OR PRESENTS THE APPEARANCE OF ORGANIZATIONAL CONFLICT OF INTEREST OR PERSONAL GAIN.
I WILL OBSERVE CLIENT’S CONFIDENTIALITY AND ANY INFORMATION RELATIN TO A CASE WILL NOT BE RELEASED TO PERSONS OR AGENCIES, OTHER THAN THOSE DIRECTLY INVOLVED, WITHOUT THE CLIENT(S) SIGNED RELEASE TO DO SO.
I WILL COMPLY WITH ALL FEDERAL AND STATE STATUTES RELATING TO NONDISCRIMINATION. SERVICE WILL BE PROVIDED TO ANY PERSON REGARDLESS OF RACE, RELIGION, COLOR, AGE, SEX, MARITAL STATUS, NATIONAL ORIGIN OR ANCESTRY.
I WILL COMPLY WITH ALL APPLICABLE REQUIREMENTS OF ALL OTHER STATE AND FEDERAL LAWS, EXECUTIVE ORDERS, REGULATIONS AND POLICIES GOVERNING THIS PROGRAM.

(Required) *I agree to the Code of Conduct

Text full name as signature *

Date