Application for Training
Contact Greater Philadelphia
P.O. Box 167
Richboro, PA 18954
(215)355-6611

Ms. Mr. Mrs. First Name:

Last Name:

Street Address 1:
Street Address 2:
City: State:
Zip Code:
Home Phone: Date of Birth:
Job Title/Occupation:
Business Address 1:
Business Address 2:
City: State:
Zip Code:
Business Phone: E-Mail Address:
Hours at Work:
Can you receive calls there? Yes No
Education Degree:
Field of Study:

Interest, Skills, Special Talents:
Why does becoming a volunteer for Contact interest you:
Do you have any health problems that might interfere with your volunteering? Yes No

If yes, please explain:
How did you hear about volunteering?
Friend: Church/Synagogue:
Media: Agency:
Employer: Contact Voluneer:
Have you been hospitalized for psychological reasons:
Yes
No
Have you ever been in therapy:
Yes
No
Are you in therapy now?
Yes
No
Have you ever been convicted of a crime:
Yes
No

Please note: Answering "yes" to these questions will not necessarily jeopardize your acceptance into the training program.

NOTE: Contact reserves the right to conduct a background check.

Availability for service: Morning
Afternoon Evening Weekend
Days available: Monday to Friday
Saturday Sunday Varied
Please list prior volunteer experience:

Please list two (2) references:

(1) Name: Phone:
Address: Relationship:
(2) Name: Phone:
Address: Relationship:

ALL INFORMATION IS HELD IN CONFIDENCE
AND AVAILABLE ONLY TO CONTACT STAFF

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Please read the following; you will be asked to sign when you come in for an interview:

I have read the Statement of Policy and Standards for Volunteer Applicants of Contact, including Standards set by Contact. I am aware of your work and objectives, and if accepted as a volunteer wil adhere to your policies. I understand that this is an application for training only. Evaluation at the completion of training will determine whether or not I will be accepted into volunteer service. I am willing to commit my services for a minimum of eight (8) hours a month.

We have found that people who have suffered a traumatic event need about a year to recover and participation in training is optimal after that period. Decisions may be reached on an individual basis.

I hereby certify that the foregoing statements are true and correct. I understand that Contact may consider any false statement on this application cause for rejection of this application and subsequent dismissal.

© 2008 Contact Greater Philadelphia