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2. Title

   1. Mr.
   2. Mrs.
   3. Ms.
4. First Name*
5. Middle Name*
6. Last Name*
8. Date of Birth*
   Date of Birth
10. Address*
12. City*
13. State*
14. Zip Code*
16. Home Phone
18. Mobile Phone
20. Work Phone
22. Email Address*
24. Do you have your own transportation?*

    1. Yes
    2. No
26. In Case of Emergency, Notify Name
28. In Case of Emergency, Notify Phone
30. Employment Status*

    1. Employed
    2. Retired
    3. Self-Employed
    4. Unemployed
32. Place of Employment
34. Title/Duties
36. Number of Years Employed
38. Supervisor
40. Regular Working Hours
42. Previous Employer
44. Reasons for Leaving
46. Volunteer Experience
    Where and activities performed.
48. Education

    1. High School
    2. Professional / Technical
    3. College
    4. Graduate School
50. Have you ever been convicted of a crime?*

    1. Yes
    2. No
52. If Yes, State Nature of Offense, When and Where Occurred
54. 1) Reference (non-related) Name, Address, Phone Number
56. 2) Reference (non-related) Name, Address, Phone Number
58. 3) Reference (non-related) Name, Address, Phone Number
60. How did you hear about Victim Service Program?
62. Are you able to commit yourself to being on-call on a given day per-week?*

    1. Yes
    2. No
64. If No, Please Explain Your Limitations and Length of Time/Commitment That You Are Able to Make
66. 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
68. 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
70. Why would you like to work with the Victim Service Unit?*
72. What additional skills and strengths would you like to develop as an outcome of your experience with this program?*
74. 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.
76. By clicking the submit button you are agreeing to a background check with the Sheriff Department.
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77. Submit

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