| Applicant Name: * |
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| Date: |
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| Address: |
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| Daytime Phone: * |
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| Evening Phone: * |
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| Email Address: * |
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| How did you hear about this? : |
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| 1. Why do you want to volunteer for VIBS? |
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| 2. Have you volunteered anywhere else? If so, where, and what type of volunteer work did you perform? |
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| 3. Why are you interested in working with children? |
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| 4. What do you think your role can be in the lives of the children? |
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| 5. When are you available? |
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Do you have access to a reliable car? |
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| 7. Do you have any special skills? (e.g., languages spoken, computer literacy, etc…)? |
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| 8. Employment background |
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| 9. Educational background |
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| 10. Please list a person to contact in case of emergency: |
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| Phone: |
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| 11. Please list the name(s) of anyone else you know of who may be interested in volunteering |
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| 12. Please list the names and numbers of at least two people who know about your work experience, especially that with children, so we can check references. |
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| Victims Information Bureau of Suffolk operates from a position of respect for all of our clients, staff and volunteers regardless of: race, sexual orientation, ethnicity, religion, ability, age or gender. Any volunteer who shows intolerance to diversity will be immediately dismissed from the program. |
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