Crisis Center
Volunteer Application Form - For Completion Online, Printing, and Mailing to Crisis Center
All information submitted on the application will remain confidential.
General information:
Name
Street Address
Address (cont.)
City
State
Zip/Postal Code
Work Phone
Home Phone
E-mail
Personal Information:
Date of Birth Sex Male Female Social Security Number:
Date of Birth
Sex
Male Female
Social Security Number:
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?
3. Do you have plans to leave this area within the next year?
4. Does your spouse/family know and approve of you doing this kind of work?
5. Do you have any physical handicaps?
6. Are you currently in good health?
7. Do you, or does anyone in your family, have a history of alcoholism, drug abuse or mental illness?
8. Have you, or has anyone close to you, ever made a suicide attempt?
9. Have you, or has anyone close to you, been a victim of sexual assault or abuse?
10. Have you ever been arrested or convicted of a felony?
11. Are you currently, or have you ever been in therapy?
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.
3. Anyone who calls the Crisis Center should, by the end of the call, decide to do something about their problem.
4. Homosexuality disgusts me.
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.
6. Talking about sex makes me uncomfortable.
7. It's OK for other people to ask for help, but for myself it is a sign of weakness.
8. Men who rape should be castrated.
9. If someone told me they were thinking of killing themselves, I would see it as my responsibility to talk them out of it.
10. People on welfare are freeloaders.
11. Religion is the answer to the world's problems.
12. The family should be preserved at all cost.
13. I would consider getting professional counseling myself if circumstances warranted.
14. It is OK to get angry with someone you care about.
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.
By submitting the above form, you are agreeing with the following conditions:
Please enter the date of this application:
After printing the application, please sign here - ___________________________________
Thank you for completing the application form.
Please print the form and mail to the Crisis Center's office at -
Crisis Center 3600 8th Avenue South Suite 501 Birmingham, AL 35222
We will contact you within one week of receiving your application.
If you have not been contacted after the one week period, plus a reasonable time for mail delivery, it is very important to us that you follow-up on your application with -
Beth Wetheral at (205) 458-8984