Weiss Child Advocacy Center Volunteer Application
* Required
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.
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By initialing below, you understand the above statement
Your answer
First Name
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Your answer
Middle Name
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Last Name
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Your answer
Maiden name or alias
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What is your date of birth?
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Ethnic Background (Completion Optional)
The following information is used to determine diversity of Weiss Advocacy Center Volunteers.
African American/Black
Asian/Pacific Islander
Caucasian
Native American
Hispanic
Other:
What is your gender?
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Male
Female
Other:
Address
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Your answer
City
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Your answer
State
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Your answer
Zip Code
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Your answer
Telephone
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Email Address
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Your answer
Please list your areas of interest
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Office Assistance
Fundraising Support
Weiss Ambassador
Family Host
Court Appointed Special Advocates (CASA)
Internship
Beautification /Gardening
Required
List current and prior volunteer experiences
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Education
Highest level of education, if applicable list your degree.
Highest Level of Education
Your answer
Field of Study
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Employment
Past Employement, position, dates
Copy and Paste your CV/Resume
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Emergency Contact
Name
Your answer
Home Address
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Telephone
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Email
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References
Due to the sensitive nature of our work, we request three professional, non-relative references.
Reference 1
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Include Phone and E-mail
Your answer
Reference 2
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Include Phone and E-mail
Your answer
Reference 3
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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?
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If yes, select other
No
Other
Required
Have you ever been convicted of a crime?
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If yes, please select other and list offense, date and disposition
No
Other:
Required
Have you ever had any felony or misdemeanor charges pending against you?
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If yes, please explain by selecting other
No
Other:
Required
Have you ever had a personal protection order (PPO) against you?
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If yes, please explain by selecting other
No
Other:
Required
Have you ever been involved in the abuse or neglect of a child or adult?
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If yes, please explain by selecting other
No
Other:
Required
Have you ever been involved with a protective service agency?
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If yes, please explain by selecting other
No
Other:
Required
Have you lived in Michigan for the past 5 years?
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If no, please list the state and years of residence by selecting other
Yes
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?
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Yes
No
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.
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Please type your initials here.
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Date of Application Submission
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