Council on Child Abuse of Southern Ohio, Inc.
Volunteer Application
Please note that required information is denoted with an asterisk. ( * )
Name:*
Phone:*
Work Phone:
Address:*
City:*
State:*
Zip:*
Social Security Number:
Date of Birth:
Email Address:
Employment*
Employer:
Position:
Supervisor:
Phone:
Education*
School:
Year Graduated:
Degree/Major:
Previous Volunteer or Related Experience:
Please include dates & duties.
Why do you want to Volunteer for the Council on Child Abuse?
How did you hear about us?
Please mark those activities which interest you the most:
PACI Hospital Volunteer
Special Events/Fundraising
Office Tasks
I would be available:
Weekdays (Morning/Afternoon)
Weekdays (Evenings)
Overnight (at my home) 		Weekends (Morning/Afternoon)
Weekends (Evenings)
Occasionally as needed
Have you ever been convicted of a crime or felony?* Yes?/No?
If yes, please explain:

Please note in compliance with Ohio Law, all volunteers
may be asked to be fingerprinted.
References:*
Name:
Address:
City:
State: Zip:
Phone:
Relationship to you:
Name:
Address:
City:
State: Zip:
Phone:
Relationship to you:
AUTHORIZATION*
"I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE."



[Main Page][Information][Annual Report][Programs][Bingo!][Volunteer Info][Make a Donation!]