Volunteer

Application

General Information:
Volunteer Work Desired
Name
Street Address
Street Address (cont)
City
State
Zip Code
Work Phone
Home Phone
Email Address
   
Personal Information:
  
Date  of Birth
    (MM/DD/YYYY)
Sex
  Male       Female
Social Security No.
     (XXX-XXX-XXXX)
   
Education & Occupation:   
Occupation
Employer/Institution
Highest Education Level
Time with Current Empl
   
How did you hear about the Crisis Center?
  
 
   
 Reason for leaving last place of employment?
  
 
   
Other volunteer experience?
  
 
   
Organizational memberships?
  
 
   
Type of volunteer work desired? (check one)
  
  Crisis & Suicide Line Counselor
  
  Rape Response Advocate
  
  Teen Link / Kids' Help Counselor
  
  Senior Talk Line Counselor
  
   
Section 1 (Answer Yes or No)
  
   
1. Do you have any previous training as a counselor?
  
  Yes    No
  
   
2. Have you ever applied to be a Crisis Center volunteer before now?
  
  Yes    No
  
   
3. Do you have plans to leave this area within the next year?
  
 Yes     No
  
   
4. Does your spouse/family know and approve of you doing this kind of work?
  
  Yes     No
  
   
5. Do you have any physical handicaps?
  
  Yes     No
  
   
6. Are you currently in good health?
  
  Yes     No
  
   
7. Do you, or does anyone in your family, have a history of alcoholism, drug abuse or mental illness?
  
  Yes     No
  
   
8. Have you, or has anyone close to you, ever made a suicide attempt?
  
  Yes     No
  
   
9. Have you, or has anyone close to you, been a victim of sexual assault or abuse?
  
  Yes     No
  
   
10. Have you ever been arrested or convicted of a felony?
  
  Yes     No
  
   
11. Are you currently, or have you ever been in therapy?
  
  Yes     No
  
   
12. If you are currently in therapy , does your therapist know and approve of your doing this kind of work?
  
  Yes     No     Not Applicable
  
   
Section 2 (Answer briefly)
  
   
1. Why did you decide to volunteer at the Crisis Center as opposed to another agency which uses volunteer staff?
  
 
   
2. What led you to apply now, i.e., at this point in your life?
  
 
   
3. What characteristics do you feel you possess that particularly suit you for this type of work?
  
 
   

4. What personal characteristics might hinder you in this type of work?

  
 
   
5. What coping techniques have you developed for dealing with stress in your life?
  
 
   
6. What are the potential dangers of getting involved in another person's problems?  
 
   
7. As a Crisis Center worker it is likely that you would at times receive calls from persons with religious or moral values different from your own. What thoughts do you have about this possibility ?
  
 
   
Section 3 (Please check the button that best represents your attitudes or beliefs)
  
   
1. If I'm a "good enough counselor", I'll be able to solve most caller/client's problems.
  
  Disagree Strongly
  
  Disagree   
  Neutral    
  Agree  
  Agree Strongly  
   
2. If a caller/client I was working with felt sad or depressed I would feel it was my responsibility to cheer them up.
  
  Disagree Strongly  
  Disagree
  
  Neutral
  
  Agree
  
  Agree Strongly
  
   
3. Anyone who calls the Crisis Center should, by the end of the call, decide to do something about their problem.
  
  Disagree Strongly
  
  Disagree
  
  Neutral
  
  Agree
  
  Agree Strongly
  
   
4. Homosexuality disgusts me.
  
  Disagree Strongly
  
  Disagree
  
  Neutral
  
  Agree
  
  Agree Strongly
  
   
5. If a caller/client said she wanted to talk about abortion, I would feel it was my responsibility to tell her that abortion is wrong.
  
  Disagree Strongly
  
  Disagree
  
  Neutral
  
  Agree
  
  Agree Strongly
  
   
6. Talking about sex makes me uncomfortable.
  
  Disagree Strongly
  
  Disagree
  
  Neutral
  
  Agree
  
  Agree Strongly
  
   
7. It's OK for other people to ask for help, but for myself it is a sign of weakness.
  
  Disagree Strongly
  
  Disagree
  
  Neutral
  
  Agree
  
  Agree Strongly
  
   
8. Men who rape should be castrated.
  
  Disagree Strongly
  
  Disagree
  
  Neutral
  
  Agree
  
  Agree Strongly
  
   
9. If someone told me they were thinking of killing themselves, I would see it as my responsibility to talk them out of it.
  
  Disagree Strongly
  
  Disagree
  
  Neutral
  
  Agree
  
  Agree Strongly
  
   
10. People on welfare are freeloaders.
  
  Disagree Strongly
  
  Disagree
  
  Neutral
  
  Agree
  
  Agree Strongly
  
   
11. Religion is the answer to the world's problems.
  
  Disagree Strongly
  
  Disagree
  
  Neutral
  
  Agree
  
  Agree Strongly
  
   
12. The family should be preserved at all cost.
  
  Disagree Strongly
  
  Disagree
  
  Neutral
  
  Agree
  
  Agree Strongly
  
   
13. I would consider getting professional counseling myself if circumstances warranted it.
  
  Disagree Strongly
  
  Disagree
  
  Neutral
  
  Agree
  
  Agree Strongly
  
   
14. It is OK to get angry with someone you care about.
  
  Disagree Strongly
  
  Disagree
  
  Neutral
  
  Agree
  
  Agree Strongly
  
   
By submitting the above form, you are agreeing with the following conditions:
  
1. I am aware that the Crisis Center's investment in each Trainee is extensive and that a firm commitment of me is expected in return.
  
2. I understand that I will be required to complete the full training course that involves a specified number of weekly sessions, plus an experiential component.
  
3. I understand that for the duration of my involvement with the Crisis Center, I may be asked by a staff member to withdraw or resign at any time.
  
4. I hereby certify that the above information is correct, and authorize the Crisis Center to verify that information through a background check.
  
   
Please enter the date of this application:   (MM/DD/YYYY)
  
Thank you for completing the application.
 
We will contact you within one week of receiving your application.
 
If you have not been contacted within one week, it is very important to us that you follow-up on your application with -
 
Valerie Shayman at (205) 458-8985.
 
Please remember to press the "Submit Application" button below. 
 
If you do not immediately receive a confirmation indicating your application has be sent electronically to the Crisis Center, please contact Valerie Shayman at (205) 458-8985.