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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.
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74. Submit

* indicates a required field