Council on Child Abuse of Southern Ohio, Inc.
Volunteer Application
Please note that required information is denoted with an asterisk. (*)
Name:* Phone:* Work:*
Address:*
City:* State:* Zip:*
Social Security #: Date of Birth:
Employment*
Employer: Position:
Supervisor: Phone:
Education*
School: (highest level)Year Graduated:
Degree/Major:
Previous Volunteer or Related Experience (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
   ("Protect & Comfort Infants")

__Office Projects

__Special Events/Fundraising


 

I would be available:
__Weekdays (Morning/Afternoon)
__Weekdays (Evenings)
 		__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:
Name: Address:
City: State: Zip:
Phone: Relationship to you:


Please return this completed Application to the Council office at:
4155 Crossgate Square
Cincinnati, OH 45236
Someone will be in touch with you to discuss your interest in volunteering.

Thank You!
 
AUTHORIZATION
"I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE."
SIGNATURE: DATE: