Volunteer Application

Personal

History

Interests

References

Agreement

STEP 01 OF 05

Personal & Contact Details

Applicant must be at least 16 years old to volunteer; applicant must be at least 18 for direct client contact.

1. Date*

First Name*

Last Name*

Middle Initial (MI)

2. Gender*

Male Female

Date of Birth (DOB)*

3. Address*

4. Primary Telephone*

Email Address*

5. Education*

6. Employed?*

Yes No

If so, where?

Job Position

STEP 02 OF 05

Background & Volunteer History

7. Volunteer History

8. Domestic Violence Work / Volunteer History

9. Have you ever been a victim of Domestic or Family Violence?*

Yes No

If so, did you receive counseling? (Please list details of counseling - when; where; length)

10. Have you ever been accused of committing Domestic or Family Violence?*

Yes No

11. Do you have a Criminal History?*

Yes No

If yes, please explain:

12. Why are you interested in volunteering with CHETNA?*

STEP 04 OF 05

References & Emergency Contact

17. Reference 1 (Professional or Personal)*

Reference 2 (Professional or Personal)*

18. Availability (Days/hours per month):*

19. Emergency Contact:*

STEP 05 OF 05

Volunteer Applicant Agreement

I certify that information provided is accurate and complete. I authorize CHETNA to verify references.

I understand completion does not guarantee volunteer status. All positions are subject to approval.

I release and hold harmless CHETNA from any liability or claims.

I understand this relationship is strictly voluntary (no monetary compensation).

I grant CHETNA permission to perform criminal history background checks and maintain confidentiality.

Applicant Printed Full Name*

Signature Date*

Personal & Contact Details

Background & Volunteer History

Areas of Interest & Qualifications

References & Emergency Contact

Volunteer Applicant Agreement

Together, We Can End Domestic Violence

Volunteer Application

Personal & Contact Details

Background & Volunteer History

Areas of Interest & Qualifications

References & Emergency Contact

Volunteer Applicant Agreement

Application Submitted!