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Volunteer Application
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How Can I Volunteer?
Volunteer Application
Personal Information
First Name:
Last Name:
Date of Birth:
Email Address:
Languages (other than English):
Phone (Home):
Phone (Work):
Phone (Cell):
Address
Address:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
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Iowa
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Ohio
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Pennsylvania
Rhode Island
South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
City:
Zip:
Education
Please select the most recent completion:
High School - 9
High School - 10
High School - 11
High School - 12
College - 1st year
College - 2nd year
College - 3rd Year
College - 4th Year
Graduate - 1st Year
Graduate - 2nd Year
Graduate - 3rd Year
Graduate - 4th Year
Field of Study / Degree:
Name of School / College:
Employment
Place of Employment:
Your position or title:
Can we call you there?
Yes
No
Employment Address:
Emergency Contact Information
Notify in Case of Emergency:
Relationship:
Emergency Contact Address:
Emergency Contact Phone:
Volunteer Experience
1. Agency:
Location:
How Long:
2. Agency:
Location:
How Long:
Do you have any special skills or services? Please List:
Please Indicate:
I have not applied to Silverleaf before
I am a past volunteer.
I have applied before
What areas are you interested in:
Please select areas in which you are willing to volunteer.
General Office Work (special mailings, phones, filing)
Fundraising/Special Events.
Hotline/Hospital Advocacy
Education/Health Fair Volunteer
How did you hear about Silverleaf?:
SL Staff/Board Member
SL Volunteer
Friend
Radio
Website
Newspaper
Health Fair
Other
Have you ever been arrested, charged or convicted of a misdemeanor or felony offense? If yes, please explain.
As part of the interview process to become a volunteer, Silverleaf will complete a criminal background check on all applicants.
I am available for training:
during the day
during evening
weekends only
anytime
References
1. Reference
First Name:
Last Name:
Phone:
Address:
2. Reference
First Name:
Last Name:
Phone:
Address:
Military
Have you served in military service branch?
Yes
No
If yes, from what dates:
Why would you like to volunteer with Silverleaf Sexual Trauma Recovery Services?
By checking here, I hereby attest that the above information is true to the best of my knowledge.
Date
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CALL 24/7 CRISIS LINE (270) 234-9236
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