Volunteer Application Form

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Name: *

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Last

Date of Birth: *

Address: *

City, State, Zip Code *

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Last

Country: *

Main Contact Number: *

Work Phone Number:

Email *

Alternate Email Address:

Employment: *

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Last

EMERGENCY CONTACT: *

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Middle

Last

Have you ever been charged with a misdemeanor or a felony? *

• Yes
• No

If yes, please explain

Do you have any special medical needs? *

• Yes
• No

If yes, please list

What skills, training, or knowledge do you wish to utilize at the Outer Banks Hotline? *

Why have you chosen to volunteer with a domestic violence agency?

Do you have any safety concerns with the population that the Outer Banks Hotline serves? (woman of domestic violence and/or woman who are homeless as a result of domestic violence) *

• Yes
• No

If yes, please explain

What are your views on the causes of domestic violence? *

We value and depend on volunteers as an extension of our services. Are you able to commit to volunteering with the Outer Banks Hotline at least four hours per month for six consecutive months?

• Yes
• No

How did you hear about the Outer Banks Hotline? *

In Which programs are you interested in Volunteering in? Please Check ALL that Apply *

• Crisis Line Volunteer*
• Hotline Outreach*
• Thrift Stores
• SA Hospital Response
• P.E.A.C.E Warrior Outreach
• Survivor Story Advocate
• Administrative
• Teen Outreach*
• Special Events
• Safe House
• Social Media Outreach
• Workshops

Authorization *

• By Submitting this Volunteer Application Form I authorize Outer Banks Hotline, Inc. to make an inquiry into the statements made by me on this application and relevant information in the volunteer consideration process. I also authorize any inquiries to be made concerning information on character, general reputation, work history, arrest record, and eligibility to work in the United States. I acknowledge and agree that any falsification, misrepresentation or omission of facts, will at the option of Outer Banks Hotline, Inc, result in making this application null and void, and will, if I become associated on a voluntary basis, result in termination of my voluntary association. I understand that completion of this application does not indicate whether there are any positions currently open and that it does not obligate Outer Banks Hotline, Inc to extend association on a voluntary basis. This certifies that the statements given on this application are true and complete to the best of my knowledge.

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