Volunteer Application - Domestic Violence Services Snohomish County

Date / Time *

Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Contact Phone *

Reference 1 Name *

Reference 1 Address *

Reference 1 Phone *

Reference 2 Name *

Reference 2 Address *

Reference 2 Phone *

Areas you are interested in: (check all that apply) *

Availability:

Days Preferred *

Hours Preferred *

Can you work:

Evenings
Weekends
Holidays

How did you learn about this program? *

Education & Work History *

Volunteer Experience *

Special Interests, skills, hobbies *

Reasons you would like to volunteer *

What is your experience with domestic violence? Have you received domestic violence services in the past year? If so please explain. *

Domestic Violence Services of Snohomish County requests a criminal history background check on all volunteers and staff. Please fill out below. Online submission represents signature.

Request for Criminal History Information

Name *

First

Middle

Last

Alias/Maiden Name(s) *

Date of Birth: (Month, Day, Year) *

Gender

Male
Female

Secondary dissemination of this criminal history record information response is prohibited unless in compliance with RCW 10.97.050.

I understand by signing below I am giving the Domestic Violence Services of Snohomish County permission to do a Washington State Background check that will be used for the sole purpose of determining my eligibility to volunteer with the agency.

As a recipient of state funds, all employees and volunteers of DVS are required to be fully vaccinated against COVID-19. *

I understand that proof of COVID-19 vaccination is required to volunteer with DVS and I agree to provide a copy of my vaccination record (or medical/religious exemption) prior to volunteering.

Comment or Message

GDPR Agreement (copy) *

I consent to having this website store my submitted information so they can respond to my inquiry.

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