Your Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender Identity

Pronouns

Race/Ethnicity Identities (optional)

Campus Affiliation

This volunteer position requires a one year commitment, are you able to give the one-year commitment?

This volunteer position requires attendance at a 36 hour helpline training. Is this something you are able to commit to?

I understand that being on call means that I am available 24/7 and am able to take shifts during the week, on weekends, and on holidays:

Please select all that apply to your experience

These are not required, we just want to get to you know you!

I have worked with trauma

I have worked on a hotline

I have worked one on one with clients

I have worked on a team

I have worked in crisis intervention

I have taught topics of gender violence

Have you ever experienced IPV?

This is very optional! Many who work in this field have lived experience, and doing this work requires self-awareness and care we wish to cultivate with you

How do you feel this might help and/or impact with your role as a helpline advocate?

Current level of education

Current Employer

(or most recent)

Position Title

Supervisor Name

First Name

Last Name

Employment Start Date

YYYY

Employment End Date

(do not fill out if currently still employed here)

YYYY

List any special skills you possess that would be an asset to our program

Are you fluent in any languages other than English? Please list which one(s).

Have you ever been arrested or charged with anything other than a minor traffic offense?

If yes, please explain:

Have you ever been convicted of a felony?

If yes, please explain:

Do you use alcohol and/or habit forming substances excessively or regularly?

If yes, please explain:

Have you ever had a protection order against you?

If yes, please explain:

Have you lived in a state other than Colorado since you were 18 years old?

Yes

If yes, please list the states and dates you lived there:

Reference 1 Name

First Name

Last Name

Reference 1 Relationship to You

Please do not include relatives or friends

Reference 1 Phone

(###)

###

####

Reference 2 Name

First Name

Last Name

Reference 2 Relationship to You

Please do not include relatives or friends

Reference 2 Phone

(###)

###

####

Reference 3 Name

First Name

Last Name

Reference 3 Relationship to You

Please do not include relatives or friends

Reference 3 Phone

(###)

###

####

Name of Emergency Contact

First Name

Last Name

Relationship to emergency contact

Phone for emergency contact

Country

(###)

###

####

Address for emergency contact

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I consent to a background check

Yes

No - I am aware this will disqualify me from becoming a helpline advocate with the PCA

By writing my name below, I certify this as a signature and that the information on this application is complete and true to the best of my knowledge. I understand that discovery of misrepresentation or omission of facts could be cause for immediate dismissal or disqualification from the application process. I authorize The Phoenix Center at Auraria (PCA) to investigate all statements contained in this application for a field placement, as well as my character and qualifications. I authorize PCA to contact any of my references for full information. I authorize all listed references to provide PCA with information requested in the inquiry of my character and qualifications. I understand that a criminal record check will be conducted on my background.

Today's Date

YYYY

Thank you for your interest in becoming a volunteer helpline advocate for the Phoenix Center at Auraria! Please email any questions to the Assistant Director of Advocacy Services, Harriet McTigue at harriet.mctigue@ucdenver.edu. If your application is selected, we will contact you as soon as possible to coordinate an interview. Please note: all volunteer advocate opportunities are contingent upon successful completion of a background check.

Volunteer Helpline Advocate Application