Today's date is required.
Your first name is required.
Your last name is required.
Your address is required.
Your city is required.
Your state is required.
Your zip code is required.
Your phone number is required.
Your email is required.
Your date of birth is required.
Please indicate your level of education.
Your occupation is required.
Why would you like to be a volunteer?
Please indicate why you are interested in volunteering.
What special qualifications or experiences do you have that would be an asset to this program?
Do you have personal or professional experience dealing with the issues of battered women/children, incest, rape/sexual assault, etc. (family, friends, yourself)? If so, please describe.
Have you ever used any WRC services (Safe Home, counseling, group sessions)?
In order to provide the best support possible, the WRC asks any potential volunteers who have utilized domestic abuse/sexual assault services to wait six months before applying to volunteer. If you answered Yes to the above question, please describe.
Have you ever been convicted or pled guilty to a criminal offense?
Do you have any felony charges pending at this time?
Have you and/or your family ever been involved in a Protective Services Investigation?
Please let us know the best time to contact you.
How much time do you have to donate? Designate days and times that are best for you.
What type of volunteer work are you most interested in doing?
Please provide three professional references:
Please provide Reference 1's name.
Please provide Reference 1's address.
Please provide Reference 1's phone.
Please provide your relationship to Reference 1.
Please provide Reference 2's name.
Please provide Reference 2's address.
Please provide Reference 2's phone.
Please provide your relationship to Reference 2.
Please provide Reference 3's name.
Please provide Reference 3's address.
Please provide Reference 3's phone.
Please provide your relationship to Reference 3.
By agreeing below, I represent that the answers and information given by me in this application are true and complete without qualification. I hereby authorize the Women's Resource Center to verify the same and to make any investigation of my background deemed necessary including, but not limited to, any records/case files that may be present within the Women's Resource Center and its programs. I realize that misrepresentation of facts called for on this application will be cause for rejection of this application.
Please agree.
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