Name *

Date of Birth *

Home address *

Phone number *

Work Phone Number

Please state your preferred method of communication:

Please provide your social security number.

Emergency Contact - Name and Phone Number *

Education - Highest Level of Education Completed *

Employment (current employer, if applicable), position title, dates of employment, *

Skills/Experience - What experiences have you had that may prepare you to work as a volunteer in the field of violence prevention, responding to critical incidents *

Groups, clubs, organizational memberships

Do you belong to a faith community? If so, what community? *

Please describe your prior volunteer experience (including organization names and dates of service) *

Why do you want to volunteer, or what do you want to gain from this experience? *

Please provide days of the week which you know or expect to be UNAVAILABLE. *

Is/has your life ever been in danger from other persons as a result of lifestyle? If yes, please explain the nature of the circumstances. *

Do you have a driver's license? *

Do you have car insurance? *

References: Please list three people who know you well and can attest to your character, skills, and dependability. Please also list the number of years you have known your reference as well as your relationship to this reference. PLEASE INCLUDE CONTACT INFORMATION FOR THE AFOREMENTIONED INDIVIDUALS (phone number and/or email address) *

Disclaimer: I understand that this is an application for and not a commitment or promise of volunteer opportunity. I certify that I have and will provide information throughout the selection process, including on this application for a volunteer position and in interviews with Neighborhood Resilience Project that is true, correct and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with Neighborhood Resilience Project or my termination as a volunteer. *