Volunteer Form (Online Application)

Directions: Complete the online application below.

If you have received shelter or services/assistance (including support groups) from any domestic violence agency or, if you have been a domestic violence victim within the past year, please contact the Direct Services/Outreach Director (910.343.9969 ext. 111) before completing this application.

This agency does not discriminate on the basis of race, color, religion, age, gender, national origin, political affiliation, sexual identity, or other non-performance factors. All volunteer assignments are at the discretion of the management of Domestic Violence Shelter and Services, Inc.

    Name

    E-mail Address

    Confirm E-mail Address

    Age

    Gender
    malefemale

    Days and Hours Available To Volunteer:

    Address

    City

    State

    Zip

    Home Phone

    Work Place

    Occupation

    Purpose in Volunteering

    Hobbies or Interests

    How did you discover the opportunity to become an advocate/volunteer

    Below is a list of possible volunteer activities, please check the ones you would be interested in. Please note: Due to the impacts of COVID-19, we have greatly limited our capacity for shelter-related volunteer activities at this time. Volunteer opportunities at our resale shops are always available.

    Other (specify)

    Past Relevant Experience

    What qualities and skills do you have that you feel would contribute in this type of work:

    What are your feelings toward a woman who elects to remain in a violent situation:

    Often children from violent homes repeat behavior they have witnessed (i.e. verbal and physical abuse). Describe your reaction toward a child who may chose to repeat aggressive behaviors in your presence:

    Any comments or questions

    Have you ever been convicted of a criminal offense
    YesNo

    If yes, please give a detailed description of the criminal offense

    Please list two (2) references (Name, Address, Relationship, Home/Work Phone):

    Reference #1

    Reference #2

    Please provide emergency contacts: (Name, Address, Relationship, Home/Work Phone):

    Person #1

    Person #2

    I certify that the above statements are true and correct to the best of my knowledge and belief. I understand that willful misrepresentation or omission of facts may prevent my serving as a volunteer. I release all persons and agencies from any and all liability which may be incurred as a result of obtaining and using this information.