Crisis Center B'ham

Crisis Center

Volunteer Application

To assure that no information is accidentally overlooked, enter "NA" for any information request that is not applicable to your situation.

General information:

	Name
	Street Address
	Address (cont.)
	City
	State
	Zip/Postal Code
	Work Phone
	Home Phone
	Email Address

Personal Information:

	Date of Birth
	Sex	Male Female
	Social Security No.

Educational/Occupational Information:

	Occupation
	Employer/Institution
	Enter your highest level of education
	How long have you been with your current employer?

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 Counselor
Rape Response
Kid's Help Line
Teen Link
Senior Talk Line

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.

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:

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.

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.

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.

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:

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 -

Emily Tucker 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 Emily Tucker at (205) 458-8985.