CONTACT We Care Volunteer

New Jersey’s Crisis Hotline (908) 232-2880

Soothing souls and saving lives

Training

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Gala Committee
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Volunteer to be a CONTACT Listener

If you prefer, you may print out and mail a Volunteer Application.

* indicates required field

What Type of Training? Traditional Flexible

Last Name *

First Name *

Age

Street Address *

City *

State *

Zipcode *

Home phone *

Work phone

Mobile phone

E-mail address *

Marital Status Single Married Divorced/Separated Widow(er)

Children # of children

Education (highest level)

High School
Voc/Trade School	Specialty
Some College	Major
College Degree	Major
Graduate Degree	Major
Other training

Life Experiences, Volunteer Work, Special Skills, etc.

Religious Affiliation / Place of Worship (if any)

City

How long?

Physical Health: describe briefly any physical disabilities that would interfere with your performance as a volunteer:

Are you taking any medication that could affect your performance as a volunteer? If yes, please specify:

Emotional Health: describe briefly any emotional traumas or crises experienced that would interfere with your performance as a volunteer:

Have you ever called a CONTACT Center?

Yes
No

If so, state reason for call:

Have you ever been arrested?

Yes
No

If so, please explain:

Have you ever worked for/volunteered for another CONTACT Center of Lifeline International?

Yes
No

If so, please state when and where:

References

Please provide three (3) references — name, address, telephone number (HIGH SCHOOL STUDENTS – please list teachers, student advisors, and/or guidance counselors)

1

2

3

Please tell us what prompted you to volunteer for CONTACT:

How did you learn of CONTACT?

Newspaper	Name
Internet Site	Website
Radio	Station
Television	Show
Volunteer Referral Agency	Name
Brochure/Newsletter
Friend/Word of Mouth	Name
Other	Specify

I affirm these statements to be true and accurate. *

If under 18, I have the consent of my parent or guardian.

Accounting/Financial	Government
Mental Health/Social Services	Administrative/Clerical
Health/Medicine	Professional
Clergy	Homemaker
Education	Management/Executive
Skilled Craft/Trade	Engineering/Technical
Marketing/Sales
Other
Retired (from)