CRISIS CALL CENTER

PO Box 8016

Reno, NV 89507

(775) 784-8085 • Fax (775) 784-8083

Volunteer Application _____ CRISIS LINES

Please Print or Type __________ SASS

Name: ___________________________________________ Phone: (home) _______________ (work) __________________

Address:______________________________________________________________________________________________

(Street) (City) (State) (Zip)

Date of Birth ___________________________________ E-mail _________________________________________________

Place of Employment/Occupation ___________________________________________________________________________

How did you hear about Crisis Call Center?____________________________________________________________________

_____________________________________________________________________________________________________

What special skills, abilities, experience, or training will you bring to the Center? _________________________________________

_____________________________________________________________________________________________________

Do you speak any languages other than English? If so, what? _______________________________________________________

Have you done any volunteer work before? If yes, what kind? ______________________________________________________

_____________________________________________________________________________________________________

With the understanding that we all have areas of sensitivity, check any issue(s) that you feel might be difficult for you:

_____ Domestic Violence _____Sexual Assault _____Child Abuse _____Substance Abuse

_____Mental Illness _____Depression _____Sexuality _____Abortion

_____Suicide _____Other: __________________________________________________________________

Please list at least 2 non-relative personal or professional references and best time to contact them:

Name Relationship Phone # Times

______________________________________________________________________________________________________

Briefly describe why you are interested in volunteering with Crisis Call Center:

______________________________________________________________________________________________________

Do you have access to a licensed, insured vehicle? _____ Yes, _____ No

Driver’s License #: ___________________________________________ State: ______________________________________

After completing your training, you are expected to commit to one year of volunteering: 4 - 4 hour shifts per month for the Crisis Lines or

3 - 12 hour on-call shifts per month for the SASS program. Will this be a problem for you? _____ Yes, _____ No

If yes, please explain: ______________________________________________________________________________________

_______________________________________________________________________________________________________

I HEREBY CERTIFY THAT ALL STATEMENTS MADE ON THIS APPLICATION ARE TRUE AND CORRECT TO THE

BEST OF MY KNOWLEDGE. I UNDERSTAND THAT BY SUBMITTING THIS APPLICATION, I AUTHORIZE

INQUIRIES TO BE MADE CONCERNING MY STABILITY AS A VOLUNTEER. ADDITIONALLY, I AGREE TO SUBMIT

TO A STATE AND FEDERAL BACKGROUND CHECK PRIOR TO COMMENCING MY VOLUNTEER SERVICE. THE

INFORMATION REQUESTED IN THIS APPLICATION, AND SUCH AS MAY OTHERWISE BE OBTAINED, WILL BE

USED ONLY FOR THE PURPOSE OF DETERMINING SUITABILITY AS A CRISIS LINES OR A SEXUAL ASSAULT

SUPPORT SERVICES VOLUNTEER. ALL INFORMATION WILL BE HELD IN STRICT CONFIDENCE.

I UNDERSTAND THIS APPLICATION, INTERVIEW, AND THE TRAINING PROGRAM IS A SCREENING PROCESS.

THE CRITERIA USED IN THE SELECTION OF VOLUNTEERS IS DESIGNED TO INSURE THAT THE INDIVIDUAL IS

ABLE TO MEET THE RESPONSIBILITIES AND EMOTIONAL NEEDS OF BOTH THE VOLUNTEER AND THE

CLIENTS SERVED BY CRISIS CALL CENTER.

IF UNFORESEEN CIRCUMSTANCES PREVENT ME FROM FULFILLING THIS ONE (1) YEAR COMMITMENT, I WILL

NOTIFY THE PROGRAM COORDINATOR IN WRITING.

APPLICANT’S SIGNATURE: __________________________________________________ DATE: ______________________