Companion Application

We are so pleased you are considering a volunteer position with our agency!
Volunteers are the very heart and soul of our organization, and we welcome you sharing your time and talents to provide services to those in our community who need a helping hand.

The information stated in this application is for the use of St. Vincent de Paul: King County Council. The information will not be shared by anyone other than the Director of Social Support Services, the Executive Director and Associate Executive Director. This application will remain under lock and key.

* Date:

* First Name:

Middle Initial:

* Last Name:

* Street Address:

Apt #:

* City:

* State:

* Zip Code:

* Telephone Number:

* Is this a cell phone?

Alternate Phone #:

* Date of Birth:

Email address:

* Occupation:

Employer Name:

Employer Street Address:

Suite #:

City:

State:

Zip Code:

Telephone Number:

* Do you have a government-issued ID?

If yes, indicate what type:

Issued by:

Number:

* Have you ever been convicted of a crime?

(This does not necessarily exclude you from consideration)

If yes, date of crime:

Location:

What convicted of:

* Do you have any outstanding warrants?

* Are you currently on probation?

* Are you currently in drug/alcohol recovery?

If yes, how long clean and sober?

Are you currently a member of a church?

If yes, name of church.

Please provide three personal references (no family members).

Reference 1:

* First Name:

* Last Name:

* Phone #:

Reference 2:

First Name:

Last Name:

Phone #:

Reference 3:

First Name:

Last Name:

Phone #:

How did you learn about the St. Vincent de Paul's Ozanam Second Chance Companion Program?

Please list volunteer experience:

Please describe your work and/or life experiences that you feel would help you be a companion for this particular population?

Briefly describe your personality.

Please describe your 'value system' or what you hold to be important in your life.

Describe your spirituality and/or prayer life.

Please state any questions you would like answered or concerns addressed before you begin a mentor relationship.

Is there anything else we should know about you?

I certify the information contained in this application is complete and true. I also understand all prospective mentors are required to submit a state of Washington background check. The results of this background check will remain confidential and will not be released beyond the administrators of the St. Vincent de Paul Ex-Offender Mentoring Program. I understand that any false statemnts will be cause for disqualification from the program.

The Society of St. Vincent de Paul does not discriminate in the placement of volunteers on the basis of race, color, religion, national origin, sex, disability, age, sexual orientation, gender identity and expression, veteran status or any other class prohibited by local, state or federal law. No question on this application is intended to secure information to be used in a discriminatory manner. Your completed application will be reviewed carefully; but its receipt does not imply that your services will be utilized. Volunteer consideration necessitates that you meet all conditions required for the position for which you are applying.

* Signature:

* Date:

* Indicates Response Required