Volunteer Application
I want to serve as (hold the control key
down to choose more than one):
FULL NAME
ADDRESS
CITY, ST, ZIP
EMAIL
CELL PHONE
HOME PHONE
OCCUPATION
BIRTHDAY
NAME OF BUSINESS
BUSINESS PHONE
BUSINESS ADDRESS
SUPERVISOR'S NAME
HOW LONG HAVE YOU WORKED THERE?
HOW LONG HAVE YOU WORKED IN THIS GEOGRAPHIC AREA?
LIST ANY ORGANIZATION IN  WHICH YOU ARE A MEMBER/VOLUNTEER
EDUCATION (click last level completed
LIST ANY PRIOR EXPERIENCE IN DEALING WITH CRISIS SITUATIONS
HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR?  IF YES, PLEASE EXPLAIN THE CIRCUMSTANCES.
WHICH DAYS OF THE WEEK
ARE YOU ABLE TO WORK?
WHAT ARE THE APPROXIMATE NUMBER OF
HOURS PER MONTH YOU COULD VOLUNTEER?
RELIABLE TRANSPORTATION AVAILABLE?
PLEASE GIVE TWO REFERENCES OF INDIVIDUALS (NON-RELATED) WHOM WE CAN CONTACT.  LIST NAMES, RELATIONSHIP,
ADDRESSES, AND TELEPHONE NUMBERS.  
WHY DO YOU WANT TO VOLUNTEER FOR THE CRISIS LINE AGENCY?
WHERE DID YOU HEAR ABOUT VOLUNTEER OPPORTUNITUES
Due to the sensitive nature of the services we offer, it is necessary to have a background check of all
applicants. This will include references and a police background check. If you are interested in pursing this
application, please sign and date the following Release of Information statement.

I understand that the training program staff will accept, without prejudice, resignations from the training
program at the conclusion of the first session (orientation), but will expect trainees to fully participate in all
training sessions thereafter.

I also understand that, should I pass the training course and be accepted as a volunteer, I will make a
commitment to serve Crisis Line as a volunteer for a minimum of one year.

Crisis Line of Central Virginia, Inc. reserves the right to discontinue the relationship with volunteers or
potential volunteers if the executive director determines it to be in the best interest of the agency.
BY ENTERING MY INITIALS, I AM STATING
THAT I UNDERSTAND AND AGREE WITH THE
ABOVE STATEMENT
DATE