Volunteer/Training Application | Altoona, PA

I am available for:*

First Shift 7am – 11am
Second Shift 11am – 3pm
Third Shift 3pm – 7pm
Fourth Shift 7pm – 11pm

Days of Week:*

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Personal Information

Name*

First Last

Address*

Street Address City State ZIP Code

Home Phone

Work Phone

Cell Phone

Emergency Contact*

Emergency Contact Phone*

CONTACT volunteer must be 18 years old and a high school graduate or equivalent at time of application.

Education, Skills and Interests

Education Background/Training:*

Current or Former Occupation:*

Hobbies, Interests, Skills:*

Volunteer Experience (list organizations and type of volunteer work):

Organization	Position

General

Write a brief statement why you wish to volunteer for CONTACT Altoona:*

What is your computer skill level?*

None
Beginner
Intermediate
Advanced

Have you taken CONTACT or Crisis Intervention training in the past?*

Yes
No

When?*

Where?*

Have you ever been convicted of a crime in any state or country?*

Yes
No

Please provide details*

Commitment (must choose one):*

Required training course, apprenticeship and one year of volunteer service on CONTACT Altoona’s Helpline at minimum 8 hours per month (No Fee- Training is FREE).
Training course for education only - no volunteer service commitment ($50 fee).

References

How did you learn about CONTACT and its volunteer training program?*

List name and phone number of two references:*

Name	Phone

Please read the Applicant’s Certification below carefully and acknowledge acceptance by your signature below: I hereby certify that the foregoing statements are true and correct to the best of my knowledge and belief and have been given voluntarily. I understand that CONTACT Altoona requires certain information both personal and professional from me to evaluate my qualifications and consider me for volunteer services. I hereby grant CONTACT Altoona permission to verify such answers and investigate all references. I understand that any false statements or incomplete information on this application may be considered sufficient cause for rejection of this application or for dismissal if such information is discovered subsequent to my volunteer work. I understand that I may be asked to discontinue my volunteer services at any time for any reason.

I understand that CONTACT Altoona will not be responsible for any personal injury or property loss that may occur to me while performing volunteer services.

I understand that I will not receive any monetary compensation from CONTACT Altoona, individual employees or anyone else for serving as a volunteer.

I hereby agree to abide by all policies and procedures of CONTACT Altoona. I will treat information regarding consumers and employees in strict confidence.

By submitting this application, I agree with the Applicant’s Certification.

Date*

Signature*