CADASI Volunteer Application

Christine Ann Domestic Abuse Services, Inc.

Thank you for your interest in volunteering. Christine Ann Domestic Abuse Services offers support, education and options to all domestic abuse victims.

We are committed to ending the cycle of violence by providing safety, support and advocacy, as well as cultivating community awareness through collaborative education and prevention programs.

We believe that each individual has value and worth, therefore:

No one has the right to abuse another person.
No one should live in fear of abuse in his or her own home.
Everyone should be empowered to make decisions regarding his or her own life.

Thank you for your interest in standing up against violence and becoming a volunteer. Once your application is received it may take two to three weeks to process and review.
If you have any questions please don't hesitate to contact us at (920)235-5998.

We look forward to hearing from you soon!

Question Title

* 1. Please fill out the following information

Name (first and last)

Preferred name

Previous/Maiden name

Date of Birth

Phone

Email Address

Current address (street address, city, state, zip)

Occupation

Current Employer

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* 2. Why you want to volunteer

Why did you choose Christine Ann Domestic Abuse Services Inc?

What does domestic violence mean to you?

Describe how you react to stressful situations

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* 3. Please Select ALL Areas of Interest

Children's Program

Community Outreach and Education

Internship

General Shelter

Group projects

Assisting Clients moving out of shelter

Special Events

Yard and Maintenance Team

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* 4. Please Answer the Following Questions

Please summarize or list any special skills and/or qualifications you have acquired from employment, volunteer work, or other activities related to volunteer interests

Please identify any limitations that might affect your ability to volunteer or perform certain tasks

Are there any special accommodations required for you to volunteer

Please list any other organizations you have volunteer for including dates and volunteer position

Please list any languages that you speak, read or write in

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* 5. Please Answer Yes or No to the Following Questions

	Yes	No
Have you ever been convicted of any criminal offense, either misdemeanor or felony, other than minor traffic violations?	Have you ever been convicted of any criminal offense, either misdemeanor or felony, other than minor traffic violations? Yes	Have you ever been convicted of any criminal offense, either misdemeanor or felony, other than minor traffic violations? No
Are you currently charged or under investigation for any violation of the law other than minor traffic violations?	Are you currently charged or under investigation for any violation of the law other than minor traffic violations? Yes	Are you currently charged or under investigation for any violation of the law other than minor traffic violations? No

If yes to either question (please specify)

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* 6. Please answer the following questions

Have you ever received services from Christine Ann Domestic Abuse Services Inc?

If you have received services from Christine Ann, please list dates of contact and advocates you worked with

Are you volunteering to fulfill a community service/ court requirement?

If volunteering to fulfill a requirement, where and who does your requirement come from and how many hours are needed to complete

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* 7. Please specify your days and times available below

	Morning	Afternoon	Evening	N/A
Monday	Monday Morning	Monday Afternoon	Monday Evening	Monday N/A
Tuesday	Tuesday Morning	Tuesday Afternoon	Tuesday Evening	Tuesday N/A
Wednesday	Wednesday Morning	Wednesday Afternoon	Wednesday Evening	Wednesday N/A
Thursday	Thursday Morning	Thursday Afternoon	Thursday Evening	Thursday N/A
Friday	Friday Morning	Friday Afternoon	Friday Evening	Friday N/A
Saturday	Saturday Morning	Saturday Afternoon	Saturday Evening	Saturday N/A
Sunday	Sunday Morning	Sunday Afternoon	Sunday Evening	Sunday N/A

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* 8. Please provide the following information for three references: first and last name, address, phone, email, relationship to the candidate, length of relationship

Reference 1

Reference 2

Reference 3

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* 9. Please type your first and last name to indicate permission for Christine Ann Domestic Abuse Services, Inc to contact the references listed to discuss suitability as a volunteer

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* 10. Please type your first and last name below to indicate the following:
By submitting this application, I affirm that facts set forth in it are true and complete. I understand that if I am accepted as a volunteer any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.
I understand the safety of the clients using a domestic abuse shelter and services, and the privacy and confidentiality of these victims is of paramount importance. I acknowledge that these considerations require the agency to carefully screen people who seek to volunteer. Further, I understand and acknowledge the decision about who will be accepted to volunteer and for what activity rests solely within the discretion of the agency.
By signing below, I hereby authorize Christine Ann Domestic Abuse Services, Inc., to investigate any information containing in the attached volunteer application. I understand this may include information on my education, employment and prior legal proceedings, and hereby authorize any and all schools, law enforcement agencies, or others to supply any information requested concerning me .