Volunteer Application Form

Please complete this application form if you are interested in becoming a OneEighty volunteer. Once you complete the form, click the Continue button at the bottom.

Contact Information

First name:

Last name:

Title:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

OK to call me here

Work phone:

OK to call me here

Cell phone:

* OK to call me here

Email address:

What kinds of email would you like to receive?

Electronic newsletters

Recruitment appeals

Demographic Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Date of birth:

(year optional)

Age range:

Gender:

Education:

Ethnicity:

Volunteer Interest

OneEighty's Volunteer Program is divided into three levels, (levels 1, 2, & 3) and the requirements vary for each level (1 to 20 hours).

Availability

Please indicate the days and times you are usually available to volunteer.

I would like to serve up to:

hours:

Volunteer and/or Work Experience

Please list your last three (3) work or volunteer held:

1

2

Employer name:

Street 1:

Street 2:

City:

State:

Zip:

Work phone:

Email address:

Special Skills/Qualifications

Please list any special skills you would like OneEighty to know about.

Please list any special skills or qualifications that would help you in a volunteer position with OneEighty.

Education

Please list your highest level of education and any additional educational experience you would like OneEighty to know about.

References

Please list three (3) professional or academic references.

1

2

First name:

Last name:

City:

State:

Home phone:

OK to call here

Home phone:

OK to call here

Work phone:

OK to call here

Work phone:

OK to call here

Cell phone:

OK to call here

Cell phone:

OK to call here

Email address:

Relationship:

Emergency Contact

Employer name:

First name:

Last name:

Street 1:

City:

State:

Zip:

Home phone:

Work phone:

Cell phone:

* OK to call here

Email address:

Relationship:

Verification & Agreement to Terms

It is the policy of OneEighty to provide equal opportunities, which means we follow the rules and regulations governing Fair Employment Practices. In addition, OneEighty will respect the applicant's right to privacy and the results of any background checks or any other information regarding the applicant will be treated confidentially.

1.) I understand that anywhere from 1 to 20+ hours of Domestic Violence & Substance Abuse core training are required in order to provide services at OneEighty.

2.) I understand that as a volunteer I may be required to complete and pass a test for illegal drug use.

3.) I understand that my volunteer position may require that I be screened for Tuberculosis (TB).

4.) I understand that I may need to submit fingerprints to the Ohio Bureau of Criminal Investigation (BCI) and/or Federal Bureau of Investigation (FBI) and pass a background check.

5.) I understand to be a volunteer with OneEighty I must be 18 years of age and I may need to provide OneEighty with proof of my high school diploma/equivalency.

6.) I understand that if I will be driving company vehicles as a volunteer for OneEighty, I must submit current copies of my driver's license and insurance, and that a driving background check will be completed.

7.) I understand that volunteers are required to provide a minimum average of 2 hours of service per week a year.

8. I understand that I may not currently or in the previous two (2) years received clinical and/or client services at OneEighty.

9. I understand that I will not be paid as a volunteer.

10. I am releasing OneEighty and its agents, associates, and related parties from all responsibilities for personal injuries and damages sustained in the performance of my volunteer position.

By submitting this application and agreeing with the Agreement to Terms with OneEighty, Inc, I am hereby stating that the answer given by me are complete and true to the best of my knowledge and belief.

I understand that any false information, omissions, or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my position as volunteer.

I understand that this application form is intended for use in evaluating my qualification for a volunteer and that this application is not an offer to be a volunteer. I further understand that if hired, my volunteer position will be considered “at-will” and that my volunteer position may be terminated for any reason, with or without cause, at anytime by OneEighty and that this application is not intended to constitute a contract of continued volunteering.

I Agree

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