CONTACT Crisis Line Volunteer Application Package

Thank you for your interest in CONTACT Crisis Line. Individuals applying for the telephone volunteer position can expect the following application and screening process to ensure that you are well-informed of the volunteer role and that it will be a successful match for you.

  1. Please review carefully the CONTACT Crisis Line Volunteer Job Description, which highlights the main components of the volunteer position. This will be signed as part of the entire application package, which includes the two criminal background check forms. Please return these completed documents via fax or mail to the attention of Director of Volunteer Services (return information is noted below).
  2. Upon receipt of your application package, you will be contacted to set up a telephone interview. This will be with the Director of Volunteer Services or their designate, and will last approximately 15 minutes. The interview will include an overview of the volunteer commitment, review of your application, and discussion about your interests and motivations for seeking to offer your valuable time to the community through CONTACT. Applicants are encouraged to ask questions and express any concerns during this time.
  3. Following the interview, reference and pertinent application information is verified along with the criminal background check.
  4. You will be contacted with a confirmation of the training class you have selected and provided with directions to the training class. The training tuition ($60; $45 for seniors 55+) will be accepted at this time.

 

Thank you for your desire to improve our community with your sacrifice of time!

 

CONTACT Crisis Line Telephone Volunteer Job Description

Responsibilities of the volunteer include, but are not limited to:

CONTACT staff is dedicated to making your service of time to the community as valuable as possible by creating a fulfilling and effective volunteer opportunity for you. Thank you for your commitment to our community!

I acknowledge and understand the above telephone volunteer duties and requirements.

 

 

 

_______________________________________ ___________________

Signature Date

_______________________________________

Printed Name

VOLUNTEER APPLICATION

Please Print All Information

NAME: LAST______________________________FIRST_______________________________MIDDLE____________

PREFERRED NAME: __________________________ MAIDEN NAME: ______________________________________

DOB: _________________________________ GENDER: _______________ MARITAL STATUS: _______________

Phone volunteer minimum age requirement is 21

STREET: ________________________________________ SOCIAL SECRUITY #: _______ - ____ - ___________

CITY: _________________STATE______________COUNTY__________ZIP: __________HOME Ph. #_____________

FAX #: __________________________ EMAIL ADDRESS: ________________________________________________

EMPLOYER: ______________________________POSITION: _________________BUS. Ph. #: __________________

BIRTHPLACE: CITY ________________________COUNTY___________________STATE _______________________

EDUCATION: HIGH SCHOOL TRADE SCHOOL COLLEGE GRADUATE OTHER

SCHOOL: _____________________________________DEGREE/FIELD OF STUDY____________________________

LIST ANY ORGANIZATIONS (CHURCHES, CLUBS, ETC.) OF WHICH YOU ARE OR HAVE BEEN A MEMBER: _________________________________________________________________________________________________

_________________________________________________________________________________________________

WHAT LANGUAGES DO YOU SPEAK OTHER THAN ENGLISH? ___________________________________________

HOW DID YOU LEARN OF CONTACT? ________________________________________________________________

PREVIOUS EXPERIENCE AS A COUNSELOR/SUPPORT PERSON OR VOLUNTEER ON ANOTHER HELPLINE:

_________________________________________________________________________________________________

DATE:_______________________WHERE: ____________________________________________________________

WHY DO YOU WANT TO BE A TELEPHONE VOLUNTEER? _______________________________________________

 

_________________________________________________________________________________________________

 

REFERENCES (Please list 3 professional references)

1. NAME _____________________________________________ RELATIONSHIP_____________________________

  1. ADDRESS_________________________________________ ZIP________ PHONE _________________________

2. NAME_____________________________________________ RELATIONSHIP _____________________________

ADDRESS _________________________________________ ZIP ________ PHONE_________________________

  1. NAME ____________________________________________ RELATIONSHIP _____________________________

ADDRESS__________________________________________ ZIP _______ PHONE _________________________

IN CASE OF AN EMERGENCY, PLEASE CONTACT:

 

NAME: __________________________________________________________RELATIONSHIP:__________________

DAY #: _____________________________________ EVENING #:__________________________________________

HAVE YOU HAD ANY MAJOR LIFE CHANGES WITHIN THE PAST 12 MONTHS (i.e. divorce, loss of a loved one,

major illness, etc.)?________________________________________________________________________________

IF SO, WHAT HAVE YOU DONE TO WORK THROUGH YOUR FEELINGS? __________________________________

________________________________________________________________________________________________

PLEASE INCLUDE THE FOLLOWING IF YOU ARE IN COUNSELING OR HAVE BEEN WITHIN THE LAST YEAR:

THERAPIST’S NAME: ______________________________________________________________________________

ADDRESS: _________________________________________________________ PHONE: _____________________

SIGN HERE FOR PERMISSION FOR DIR. OF VOLUNTEER SERVICES TO CALL YOUR THERAPIST FOR REFERENCE: _______________________________________________________________________________________________

ARE THERE ANY PERSONAL PROBLEMS, FAMILY OR BUSINESS OBLIGATIONS AND/OR ACTIVITIES,

(I. E. TRAVEL), THAT MIGHT MAKE IT DIFFICULT FOR YOU TO FULFILL YOUR COMMITMENT AS A VOLUNTEER? ____________________________________________________________________________________

I AM INTERESTED IN VOLUNTEERING IN THE FOLLOWING AREAS:

t Telephone Volunteer t Administrative t Speakers’ Bureau

t Fund Raising/Special Events t TEEN Program t Marketing / PR

 

In order to assist in the cost of training, all volunteers are charged $60 ($45 for senior citizens 55+).

*Checks, Cash, VISA and MASTERCARD accepted.

 

You may mail application and payment to: CONTACT, P. O. BOX 800742, Dallas, Texas 75380-0742.

If you have any questions or would like more information, call the business office at 972-233-0866 (Fax 972-233-2427).

 

DUE TO THE NATURE OF OUR SERVICES, CONTACT RESERVES THE RIGHT TO CONDUCT A CRIMINAL BACKGROUND CHECK ON ALL WHO ATTEND OUR TRAINING COURSE AND/OR VOLUNTEER AT OUR AGENCY.

 

The information given on this application is true and approval is given for reference and criminal background checks.

 

 

 

 

X_________________________________________________________________ ________________________________________________

SIGNATURE DATE

 

 

 

 

 

Criminal Background History

  1. I have____ have not____ been convicted within ten (10) years preceding this date of a felony or a misdemeanor within the prohibited class or felony violation of any statute intended to control the possession or distribution of any substance included as a controlled substance in the Texas Controlled Substance Act.

    If your answer is affirmative, please give details; include date, place, nature of conviction and disposition.

    _______________________________________________________________________

    _______________________________________________________________________

  2. I am____ am not____ currently under indictment or charged in an official criminal complaint accepted by a district or county attorney with a felony or misdemeanor within the prohibited classes. If your answer is affirmative, please give details; include the type of charges.

    _______________________________________________________________________

    ______________________________________________________________________

  3. I have____ have not____ ever been prohibited from serving in any capacity (as an employee or volunteer), or asked to leave any position involving contact with children. If your answer is affirmative, please give details; include the type of charges and/or reasons.

______________________________________________________________________

______________________________________________________________________

4 Have you ever entered a plea of guilty, no contest, nolo contendere or plea other than not guilty to a

crime? If yes, please describe.

________________________________________________________________________

________________________________________________________________________

6. Are you on probation? If yes, please describe.

________________________________________________________________________

________________________________________________________________________

Drivers License # and State_______________________ How many years in state_____

I have read this form in its entirety and understand that the information may be verified by CONTACT Crisis Line, and that falsification of any information is cause for my immediate dismissal from volunteer placement at CONTACT Crisis Line. I agree to inform CONTACT Crisis Line if this information changes at any time during my participation at CONTACT Crisis Line. This document will be destroyed after the check has been completed and reviewed.

________________________________________ ______________________

Signature of Volunteer Date

________________________________________

Print Name

 

 

Background Verification Release Form

AGENCY INFORMATION

Date

Agency Name

CONTACT Crisis Line

Contact Name

Thomas Hutter

Agency’s Main Phone Number

972-233-0866/ ext 311

Agency’s Fax Number

972-233-2427

APPLICANT INFORMATION:

Applicant Full Name (Last, First, MI)

Current Address

City State Zip Code

County

Social Security Number

Date of Birth

Driver’s License Number

State Issued

Gender

q Male q Female

Race q African American q American Indian q Anglo q Asian q Hispanic q Other

I hereby authorize veriFYI and or its Service Provider to request and receive any and all background information about or concerning me, including but not limited to my Criminal History, Credit History including a consumer report under the Fair Credit Reporting Act, 15 U.S.C 1681, Driving Record, Employment History, Military Background, Civil Listings, Educational Background, Professional License from any Individual, Corporation, Partnership, Law Enforcement Agency, and other entities including my Present and Past Employers.

The criminal history, as received from the reporting agencies, may include arrest and conviction data as well as plea bargains and deferred adjudications and delinquent conduct as committed as a juvenile. I understand that this information will be used, in part, to determine my eligibility for an employment/volunteer position with this organization. I also understand that as long as I remain an employee or volunteer here, the criminal history check may be repeated at any time. I understand that I will have an opportunity to review the criminal history as received by client/agency and a procedure is available for clarification, if I dispute the record as received. I also understand that the criminal history could contain information presumed to be expunged.

I further release and discharge veriFYI and their Service Provider and all of their Subsidiaries, Affiliates, Officers, Employees, Contract Personnel, or Associates, from any and all claims and liability arising out of any request for information or records pursuant to this authorization, procurement of an investigative consumer report and understand that it may contain information about my character, general reputation, personal characteristics, and mode of living, whichever are applicable.

I understand that I have the right to make written request within a reasonable period of time to VeriFYI for additional information concerning the nature and scope of the investigation. I acknowledge that I have voluntarily provided the above information for employment/volunteer purposes, and I have carefully read and understand this authorization.

 

 

 

Applicant’s Signature

 

Date

 

Applicant’s Printed Name

Parent/Guardian’s Signature

(if under 18 years of age)