Volunteer Application Page

Emergency Contact
Name*
First Last
Relationship*
Home/ Cell Phone*
Work Phone
Please list three personal references with addresses & phone numbers:*
Have you had any of the following:*
- Prior abuse or molestation allegations
- Incidents, convictions, or pleading of guilty or "no contest" to misdemeanors
- Incidents, convictions, or pleadings of guilty, or "no contest" to felonies
- None of the above
Please explain any yes answers from the previous question.
Agree by checking the boxes.*
- I understand that SAFE, Inc. will conduct a mandatory background check prior to my being admitted to the volunteer program. I agree to hold harmless SAFE, Inc. and any reference(s) provided by me should I not be in agreement with the reference(s).
- I pledge to keep the location of the SAFE, shelter and the names of the clients confidential. I will respect and maintain confidentiality on all information pertaining to clients who seek help from the program. If I violate this pledge, I will automatically be terminated as a volunteer.
- I, __________________, am willing to serve as a volunteer for SAFE, Inc. shelter. I agree to release SAFE, from all liability for any injury or personal damage I might contact the Volunteer Services Coordinator or the Executive Director as soon as possible. If I choose to discontinue my volunteer work with SAFE, Inc., I will submit in writing a two week notice.
- I understand that untruthful answers are grounds for dismissal or refusal of my Volunteer application.
Signature*
First Last
Date*
MM slash DD slash YYYY
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Volunteer Application

Emergency Contact

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