Crisis Intervention Companion Application

Your Personal Information

First Last

Your Email Address

Enter Email Confirm Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Phone

Best Time To Call You

When is the best time for us to reach you via telephone?

Do you have reliable transportation?

Yes

Hours You Are Available for Volunteering

Please tell us what hours you are available to volunteer, this volunteer position responds outside of business hours.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Your Previous Experience

Previous Volunteer Experience

Please list your previous volunteer experience, the dates you worked and the position you held.

Organization

Dates

Position

Phone

How long are you willing to commit to volunteering? 9e.g., 1 month, 6 months,etc.)

Are you at least 18 years old at the time of training?

Yes

Are you willing to undergo a background check?

Yes

Are you able to commit to being a volunteer for at least one year?

Yes

Are you able to turn in the required paperwork and documentation?

Yes

Have you previously worked in crisis intervention? (Yes/No) If yes, please describe your experience:

Do you have any relevant training or certifications (e.g CPR, First Aide, etc.)?

Why do you want to volunteer as a Crisis Intervention Companion?

What skills or strengths do you bring to this role?

Are you comfortable providing emotional support to a recent victim of sexual assault.

Yes

Are you able to follow instructions and adhere to safety protocols as well as our confidentiality polices?

Yes

Have you ever been convicted of a crime? (Yes/No) If yes, please provide details:

References

Please provide 3 references (non-family members) who can speak to your character and qualifications.

Name

Relationship

Phone

Tell Us About Yourself

Upload Your Resume

Upload your resume in .pdf, .doc or .docx format

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Upload Your Cover Letter

Upload your cover letter in .pdf, .doc or .docx format

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Acknowledgment(Required)

I agree to volunteer my time and services to the organization and acknowledge that I have provided accurate information to the best of my knowledge.

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