Apply here

Date

First name

Last name

D.O.B

Another name you go by.

What location are you applying to?

Huntsville

Livingston

Trinity

San jacinto

Phone

Country/Region

Address

City

Zip / Postal code

Employer

Ocupation/Title

Marital Status :

Single

Married

Divorced

Widowed

How many hours per week would you like to volunteer?

Are you volunteering to fulfill a court-ordered community service requirement?

Yes

If yes, How many hours are you required to complete?

By when?

Are you currently on probation, parole, or completing service hours?

Yes

If yes, explain:

Have you been arrested, charged, or convicted of an assault or felony?

Yes

If yes, explain:

Have you been under investigation through TDFPS(CPS and/or APS)?

Yes

If yes, explain:

Education/Skills:

Are you currently a student?

Yes

Name of School:

Licenses/Certifications

Describe other training, skills, or talents:

Volunteer/Employment Experience - Program/ Agency

Position

Supervisor

Single choice

Option 1

Option 2

References :

Reference 1

Name

Relationship

Phone and or Email

Reference 2

Name

Relationship

Phone and or Email

Reference 3

Name

Relationship

Phone and or Email

Are you fluent in any other languages other than English?

Yes

If so, what language(s):

Speak

Read

Write

Do you need special accommodation for your volunteer expirience?

Yes

Please Explain:

Are there any restrictions on your volunteer capabilities?

Yes

Please explain:

Have you ever been convicted of a law violation (other than routine traffic violation)?

Yes

Please explain:

Have you, your spouse, or a family member ever received services from the SAAFE House?

Yes

Unsure

If yes, please explain in a separately attached document

I understand that volunteers are required to always maintain confidentiality during and after their volunteer assignments and that violation of this confidentiality is cause for termination of my volunteer services.

I understand that the misrepresentation of the information requested us the cause for the termination of my volunteer services. I authorize the investigation of all statements contained in this application.

SAAFE House has the right to conduct a criminal background check and by signing below, you authorize the investigation of all statements made in this application. Further, by signing below , you agree that you understand these terms as stated and have answered all questions truthfully.

Signature

Direct Services & Advocacy.............(Requires additional training. This is going to provide you with everything that you need to potentially have your own caseload at the office or to help cover shifts in our shelter)

Community Relations

Events

Marketing

Group Volunteering

Special Project Groups

To learn more details about each position follow the link down below.

https://www.saafehouse.org/voluteer-internship

Please add any additional skills or talents not mentioned:

Emergency Information

Name (first middle last)

Adress

Emergency Contact Phone Number

DOB

Signature

Date

Relationship to Applicant

Return Completed Applications to:

SAAFE House

1426 Sam Houston Ave.

Huntsville, TX 77340

List any existing medical conditions (diabetes, hypertension, etc.)

List all allergies to foods, medications, etc. and describe symptoms of reactions:

List all medications taken regularly if any..

I give SAAFE House permission to release the above information to appropriate personnel in the even of an accident or medical emergency.

Date

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