Family Life Center-Safehouse Volunteer Application
The mission of the Family Life Center is to provide comprehensive services to the victims of domestic violence, child abuse and sexual assault/abuse, with special attention to each client's individual needs without regard to the individual's race, color, sexual preference, religion or belief.
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First Name: *
Last Name: *
Date of Birth: *
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DD
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Address: (include city, state, zip code) *
Email *
Phone Number: *
Emergency Contact: (Please list the name and phone number) *
Have you ever been convicted of a crime? *
What were you convicted of?
The following shifts are available; please check the shifts that you would be available for: *
Required
Please List three (3) references: *
Signature:
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