Athens County Child Advocacy Center. Volunteer/Intern Application

Transcription

1 Athens County Child Advocacy Center Volunteer/Intern Application 444 W. Union St. Suite B Athens, OH info@athenscac.org athenscac.org Date of Application: Name: Contact Information Local Address: Permanent Address: Home Phone: Cell Phone: Address: Preferred Method of Contact: Cell Phone Home Phone Employment Name of Present Employer (if any): Address of current job: THREE previous jobs: Previous volunteer experience: Page 1 of 6

2 Education Circle highest level completed: High School: College: Graduate: Name of current school, program, and major: Would you be completing your volunteer hours at the CAC for a class? No Yes If yes, what class?. How many hours do you need to complete?. What is the time period you would like to complete these hours? Background Information Do you drive? If yes, include driver s license number: Do you have an automobile available to you? Do you have car insurance? Have you had any automobile citation and/or accidents in the last five years? If yes, please explain: Have you or any members of your immediate family ever had any involvement with Athens County Children Services or any other children services agency? If yes, please explain: Have you ever been arrested for a crime? If yes, please explain: Page 2 of 6

3 Do you have any physical or emotional limitations that need to be considered at the Athens County Child Advocacy Center? If yes, please explain: Is there any reason you would not be able to work closely with law enforcement or children services? If yes, please explain: Experience Please check which volunteer position you are applying for- General Office Assistant Community Education and Prevention Child and Family Interaction Fundraising What interests you about this position? Skills valuable to this area? How did you hear about the Athens County Child Advocacy Center? Why do you want to volunteer with the Athens County Child Advocacy Center? Page 3 of 6

4 Do you have experience working with children? If yes, what ages? If yes, please explain(what capacity, professional or volunteer, in what environment): Do you have any prior knowledge regarding the subject of child abuse? If yes, please explain (training, education, professional experience): Name 3 things you would like to learn from volunteering with the Athens County Child Advocacy Center: The Athens County Child Advocacy Center strives to meet the diverse needs of people within Athens County; based on race, gender, sexual orientation, class, age, etc. Please explain ways you can promote, participate, or support this work: Tell us about the strength(s) you have to bring to the Athens County Child Advocacy Center and working with families in crisis: Page 4 of 6

5 Professional References Name: Affiliation: Address: Home Phone: Cell Phone: Work Phone: Address: Length of time known by applicant: Name: Affiliation: Address: Home Phone: Cell Phone: Work Phone: Address: Length of time known by applicant: Name: Affiliation: Address: Home Phone: Cell Phone: Work Phone: Address: Length of time known by applicant: Page 5 of 6

6 Athens County Child Advocacy Center Affirmation and Release for Volunteers/Interns I hereby affirm that all of the responses provided on my application are true. I hereby authorize the Athens County Child Advocacy Center to contact my references to determine my fitness as a potential volunteer/intern. I understand that the information requested in this application will be used only for the purpose of determining suitability as an ACCAC employee. I understand that all volunteers must have a background check completed before working at the Athens County Child Advocacy Center. I also understand it is my responsibility to have this completed and paid for. Signature Print Name Date: Athens County Child Advocacy Center 444 W. Union St. Suite B Athens, OH (740) hannah@athenscac.org Page 6 of 6