Weiss Child Advocacy Center Volunteer Application
Weiss Child Advocacy Center has the right to reject any applicant found to have been convicted of, or having charges pending for, a felony or misdemeanor involving a sex offense, child abuse or neglect, or related acts that would pose risks to children or Weiss Child Advocacy Center's credibility. *
By initialing below, you understand the above statement
Your answer
First Name *
Your answer
Middle Name
Your answer
Last Name *
Your answer
Maiden name or alias
Your answer
What is your date of birth? *
MM
/
DD
/
YYYY
Ethnic Background (Completion Optional)
The following information is used to determine diversity of Weiss Advocacy Center Volunteers.
What is your gender? *
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Telephone *
Your answer
Email Address *
Your answer
Please list your areas of interest *
Required
List current and prior volunteer experiences
Your answer
Education
Highest level of education, if applicable list your degree.
Highest Level of Education
Your answer
Field of Study
Your answer
Employment
Past Employement, position, dates
Copy and Paste your CV/Resume
Your answer
Emergency Contact
Name
Your answer
Home Address
Your answer
Telephone
Your answer
Email
Your answer
References
Due to the sensitive nature of our work, we request three professional, non-relative references.
Reference 1 *
Include Phone and E-mail
Your answer
Reference 2 *
Include Phone and E-mail
Your answer
Reference 3 *
Include Phone and E-mail
Your answer
Questionare
How did you learn about volunteer opportunitites at The Weiss Advocacy Center?
Your answer
Do you have any physical limitations? *
If yes, select other
Required
Have you ever been convicted of a crime? *
If yes, please select other and list offense, date and disposition
Required
Have you ever had any felony or misdemeanor charges pending against you? *
If yes, please explain by selecting other
Required
Have you ever had a personal protection order (PPO) against you? *
If yes, please explain by selecting other
Required
Have you ever been involved in the abuse or neglect of a child or adult? *
If yes, please explain by selecting other
Required
Have you ever been involved with a protective service agency? *
If yes, please explain by selecting other
Required
Have you lived in Michigan for the past 5 years? *
If no, please list the state and years of residence by selecting other
Required
Are you willing to sign a release of information of any and all criminal records, any and all CPS history, and sign a confidentiality disclosure? *
Required
By initialing here, you agree to notify Weiss Child Advocacy Center of any pending felony or misdemeanor charges within 10 days after first date of service. *
Please type your initials here.
Your answer
Date of Application Submission
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This form was created inside of Voices for Children Advocacy Center. Report Abuse - Terms of Service