Volunteer Application 1Basic Info2Background Info3Background Info (Part 2)4Work Experience5References & Other Info Basic InformationName(Required) First Last Date of Birth(Required) MM slash DD slash YYYY Address Street Address City State / Province / Region ZIP / Postal Code Do you have personal transportation? Yes No Home Phone NumberCell Phone NumberEmail(Required) Background InformationAre you currently employed? Yes No If yes, description of employmentList any languages, other than English you speak: List any special skills, training, interest or hobbies that you have that may be useful to VCR ProgramEducation Background None High School Diploma GED College Degree Name Of College: Dates Attended: Degree Received: Volunteer Experience: Please List any other community activities: Background Information (Part 2)Have you had any traumatic experiences that would benefit or jeopardize your participation on the VCR TeamIs there anything in your past that might disqualify you from functioning as a Victim Crisis Responder for the Fox Valley Police Departments? (Domestic violence, child abuse, batter, etc.) Yes No If yes, please describe briefly Work ExperienceMost recent first---within the last five years1) Business Name & Job Title Job Duties2) Business Name & Job Title Job Duties3) Business Name & Job Title Job Duties References & Other InformationList 3 personal references other than a significant other or family.1) Personal Reference Name Personal Reference Phone #Relationship 2) Personal Reference Name Personal Reference Phone #Relationship 3) Personal Reference Name Personal Reference Phone #Relationship In case of emergency, please contact:Name First Last PhoneRelationship to Volunteer Provide A Brief Personal HistoryProvide A Brief Personal History along with a description of interests in the program. Then explain what you would like to learn during the training sessions.(Required)Consent(Required) I ConsentNote: Due to the sensitivity of the role, and limited spots in training some applicants may not be accepted into the program. Only successful applicants will be contacted.
