Volunteer Victim Advocate Application

All applicants are considered without regard to race, color, religion, sex, national origin, age, marital or veteran status, or handicap.

Name(Required)

Date(Required)

Address(Required)

Home Phone

Cell Phone

Employer

Employer Address

Driver's License Number

Exp. Date

Have you ever had a traffic ticket?(Required)

Yes

Have you ever had your driver's license suspended?(Required)

Yes

If you answered yes to either of the above, please explain.(Required)

Have you ever been convicted of a felony?(Required)

Yes

If you answered yes, please explain.(Required)

If you are *fluent in a language other than english, please indicate the language:

(*fluent indicates that you can read, write and speak the language without hesitation.)

List any professional, trade, business, or civic activities you are involved in and any offices held:

Have you ever filled out an application or been employed with us?(Required)

Yes

If Yes, Please give dates.(Required)

Please summarize any special skills, qualifications and experience that you would bring to Safehouse as a volunteer victim advocate.

Please explain why you would wish to become a volunteer victim advocate.

Please state any additional information you feel may be helpful to us in considering your application.

List two references that are not related to you:

Name(Required)

Address(Required)

Phone(Required)

Years known(Required)

Name(Required)

Address(Required)

Phone(Required)

Years known(Required)

After submitting this form, the following page will have information about the required victim advocate training that can be completed online.