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VOLUNTEER APPLICATION

PERSONAL INFORMATION

Name:
Date of Birth:
Address:
City:
State:
Zip Code:
Email:
Home Phone:
Cell Phone:
Gender:

Male
Female

 
Occupation:
Employer:
Previous Employer:
Have you ever called a hotline? Yes
No

 
How did you hear
about us?
(Check all that apply)

Radio
TV
Newspaper
Website
Other
Volunteer/Recommendation:

 

 

EDUCATION INFORMATION

Current Student? Yes
No
If Yes, what's your major?
Which School?
Past Education:
Languages spoken fluently:


REFERENCES
(Local Adults, no relatives, you must provide three)

Reference 1
Name:
Address:
Phone:
When to call:
Years known:

Reference 2
Name:
Address:
Phone:
When to call:
Years known:

Reference 3
Name:
Address:
Phone:
When to call:
Years known:

 

PREFERENCES

Preferred Training/Work Location:
(Choose One) 		Central (Houston)
Bay Area (Clear Lake)

 

Interested in volunteering for: Central Hotline
Bay Area Hotline
Spanish Hotline
Teenline
Office
Projects
Special Events

 


Why are you interested in volunteering with Crisis Intervention of Houston, Inc.?

 

Have you done volunteer work?

Yes
No

 

If yes, describe and tell us when and where below.

 

What personal qualities do you think an effective Hotline volunteer should have?

 

What do you expect to gain from working on the Hotline?

 

Please comment on any limitations or feelings you have that may affect you
as a Hotline volunteer.

 

Are you taking medication?

Yes
No

 

If yes, describe and tell us when and where below.

 

Please describe any medical or psychological condition(s), present or past,
that require(d) counseling or hospitalization.

 

Have you been convicted of a crime other than a misdemeanor?

Yes
No

 

If yes, describe when, where and the nature of the offense.

 

Are any charges currently pending?

Yes
No

 

Consider your life over the next 12 months (moves, job changes, time/work, family commitments, school, etc.) Do you feel reasonably certain of your ability to complete the volunteer commitment of eight months after training?

Yes
No

 

READ CAREFULLY BEFORE ACKNOWLEDGEMENT
As a volunteer of Crisis Intervention of Houston, Inc. (CIH), I recognize that I will be exposed to confidential information relating to crisis calls, callers, volunteers and other matters. In that regard, I agree not to discuss, reveal or otherwise disclose to any individual or entity the content or substance of any communication with a caller except to other CIH personnel, director, any individual or entity pursuant to CIH policies and procedures or to any individual or entity in response to legal process, or when appropriate, to court order.

I further agree not to disclose to any individual or entity not an employee, director or volunteer of CIH the physical location of any CIH facility, or the identity (including the name, phone name, address or phone number) of any CIH volunteer.