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Domestic Violence Crisis Response Teams Volunteer Application

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Victim Service Agency: BCDHS/ADV





List your last two places of employment:

A BACKGROUND CHECK WILL BE CONDUCTED ON ALL APPLICANTS. ALL VOLUNTEERS MUST BE AT LEAST 21 YEARS OF AGE. ALL VOLUNTEERS ARE BEING ASKED TO COMMIT TO ONE YEAR OF SERVICE AND MUST COMPLETE A 40-HOUR TRAINING COURSE TO BE ON A CRISIS RESPONSE TEAM.

Please list at least 2 additional references, who are responsible adults of reputable standing in their communities, excluding family, who have known you for at least three years, and can attest to your ability to serve as a volunteer.

I CERTIFY THAT ANSWERS GIVEN HEREIN ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT ANY MISREPRESENTATION BY ME WILL BE SUFFICIENT CAUSE FOR REJECTION OF THIS APPLICATION OR FOR DISCHARGE FROM SERVICE ON A BERGEN COUNTY CRISIS RESPONSE TEAM. I UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS LISTED ABOVE. I HEREBY GIVE PERMISSION TO MY LOCAL POLICE DEPARTMENT OR BCDHS/ADV TO CONTACT ANY REFERENCES LISTED AND TO CONDUCT A CRIMINAL BACKGROUND CHECK FOR THE PURPOSE OF ASSESSING MY APPLICATION TO PARTICIPATE ON THE BERGEN COUNTY DOMESTIC VIOLENCE CRISIS RESPONSE TEAM.


Please use "Submit and Print" below so you can print this form, sign it, and then fax to 201-336-7555.
 
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