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Sheriff's Victim Services Unit Application

2. Title

   1. Mr.
   2. Mrs.
   3. Ms.

4. First Name*

5. Last Name*

7. Address*

9. City*

10. State*

11. Zip Code*

13. Home Phone

15. Mobile Phone

17. Work Phone

19. Email Address*

21. Do you have your own transportation?*

    1. Yes
    2. No

23. In Case of Emergency, Notify Name

25. In Case of Emergency, Notify Phone

27. Employment Status*

    1. Employed
    2. Retired
    3. Self-Employed
    4. Unemployed

29. Place of Employment

31. Title/Duties

33. Number of Years Employed

35. Supervisor

37. Regular Working Hours

39. Previous Employer

41. Reasons for Leaving

43. Volunteer Experience

    Where and activities performed.

45. Education

    1. High School
    2. Professional / Technical
    3. College
    4. Graduate School

47. Have you ever been convicted of a crime?*

    1. Yes
    2. No

49. If Yes, State Nature of Offense, When and Where Occurred

51. 1) Reference (non-related) Name, Address, Phone Number

53. 2) Reference (non-related) Name, Address, Phone Number

55. 3) Reference (non-related) Name, Address, Phone Number

57. How did you hear about Victim Service Program?

59. Are you able to commit yourself to being on-call on a given day per-week?*

    1. Yes
    2. No

61. If No, Please Explain Your Limitations and Length of Time/Commitment That You Are Able to Make

63. Will you be able to attend in-service training sessions at the Sheriff's Office, in addition to your regularly scheduled volunteer time?*

    1. Yes
    2. No

65. Every effort is made to accommodate the preference of applicants. However, the size of the Victim Service Unit necessitates scheduling volunteer assignments over the course of the work-week.*

    Please check each time(s), and day(s), you would be able to volunteer.

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
    7. Sunday
    8. Holidays
    9. Days
    10. Afternoons
    11. Evenings
67. Why would you like to work with the Victim Service Unit?*

69. What additional skills and strengths would you like to develop as an outcome of your experience with this program?*

71. As a volunteer you will be working with clients of many different ethnic and social-economic backgrounds. Sometimes clients may have values or beliefs quite different from your own. Please describe why this will or will no present a difficulty or adjustment to you as a service provider.

73. By clicking the submit button you are agreeing to a background check with the Sheriff Department.

    By clicking the submit button you are agreeing to a background check with the Sheriff Department.

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74. Submit

* indicates a required field