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
Non-Binary
Prefer not to answer

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.

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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