Application for Training Contact Greater Philadelphia Mr. Mrs. Ms. First name: Last Name: Street Address 1: Street Adresss 2: City, State, Zip: Home Phone: Date of Birth: Job Title/Occupation: Business Address 1: Business Address 2: City, State, Zip: Business Phone: E-Mail Address: Hours at Work: Can You Receive Calls there? Yes No Education Degree: Field of Study: Interest, Skills, Special Talens: 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 Volunteer: 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 NOTE: Contact reserves the right to conduct a background check. Availability of Service: Morning Afternoon Evening Weekend Availability of Service: 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 / 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.