Crisis Intervention Services

To our potential volunteer,

We’d first like to thank you for your interest in volunteering for Crisis Intervention Services. We’re very proud of our staff of volunteers, who come from widely diverse backgrounds and experiences, and we hope to be adding you to the team.

We’d also like to note that, because volunteers deal with some sensitive issues on our CRISISline and TEENline, we find it helpful to assess potential volunteer readiness. We’d like to stress that there are some questions in this inquiry that require in-depth personal reflection. Any answer you give is welcomed and does not necessarily guarantee nor exclude your involvement with Crisis Intervention Services. Your answers simply help us gauge your strengths and needs in order to better understand how we might support you in your work on the lines. Additionally, this application is confidential.

Because your replies keep us informed on the effectiveness of this application, we encourage not only your sincere responses to the questions, but also your reactions to the questions themselves. If you need any assistance as you complete this application, please email or call 467-3347 to speak to a staff member. Please visit if you would like more information on our programs.

Thank you again,
Your CIS Staff

Personal Information

Name______Home Phone______Birth Date______

Address______City______State_____ Zip______

Email Address: ______

Emergency Contact Name______Emergency Number______

Employment/Education Volunteer Experience Information

If you are employed, please list your workplace. How did you hear about Crisis Intervention Services?

______

What position do you hold?______Have you applied to volunteer here before?______

______If so, when?______

How long have you been there?______Where else have you volunteered?______

May we call you at work?______

Work Phone______List your other training or experience you believe will help you

What is the highest education level or degree ______

you have completed?______

If degree, in what focus?______

______What transportation will you use to get to training/shifts?

Educational honors, awards or organizations ______

______Have you ever been convicted of a crime other than a minor

______traffic violation?______

Taking Care of You Views on Helping

Have you within the past year or are you How do you define helping?

currently seeing a therapist?______

If so, may we contact your therapist,

solely to discuss the appropriateness of

your participation in Crisis Intervention

Services?______

Therapist Information: How does being listened to help anyone?

Name______

Number______

If you are on any medication that may

affect your ability to work, concentrate

or react appropriately to crisis, please

indicate the medication(s) and effects: What significance does non-judgment have when listening to someone?

______

______

______

______

Because speaking with suicidal callers Briefly describe either a time when you exercised non-judgment or a time

can bring up difficult feelings, we need when you realized you were being judgmental and how that felt.

to ask if you have ever considered or

attempted suicide yourself.

 Considered  Attempted

If you have considered or attempted

suicide, please let us know when this

occurred and how you dealt with or are

currently dealing with the issues

surrounding the thoughts or attempt? Please describe a difficult experience from your own life and briefly discuss

______how you handled it.

______

______

______

______

______

______

______

______

Life Events Survey Personal Responses to Stress

Please check any of the following events that you If you wish to elaborate on any of the items you checked in the

have experienced within the last year or expect to left-hand column, please do so here.

experience within the next year.

Death of a significant other:

Spouse/Partner

Parent

Sibling

Child

Friend

Break-up or change in personal relationship How do you feel you might respond to your inability to find out

Divorce or separation what has happened to a caller after the call has ended?

Marriage

Drug/alcohol abuse in self

Drug/alcohol abuse in someone close to you

Sexual abuse or assault

Eating disorder

Change in job status or conditions

Movement to a new home Where or to whom do you turn when you need support?

Significant weight loss or gain

Participation in a recovery program or group

Health problems in self

Health problems in someone close to you

Serious injury to self How do you take care of yourself when you are stressed?

Serious injury in someone close to you

Shift in religious philosophy or involvement

Change in financial status

Experience of abuse or violence

Enrollment in or graduation from school For each of us, there are situations or issues that are difficult for

Birth, adoption or loss of a child us to listen to. What kinds of issues might be more emotionally

Sleeping difficulties taxing for you than others?

Major personal achievement

Arrest or charges for violating a law

Hospitalization

Change in social relationships

Suicide attempt:

in self

in someone close to you

Completed suicide by a significant other

Self-mutilation/Self-harm

Therapy or counseling

Issues Discussion

For the following list of issues, please write briefly about either your personal beliefs on the issue and how they affect your life or about an experience that caused you to examine your feelings on this issue. No answer is considered right or wrong. We are not looking for a specific response, only a better view of where you stand on issues about which many people have strong feelings.

Sexual Diversity—Homosexuality, bisexuality, transgender issues, etc.

Religion

Abortion

Mental Illness

Poverty and Welfare

Suicide

Strengths Review

Tell us something you are good at or something you enjoy. What of your strengths does your example highlight?

Your answer does not necessarily need to relate to volunteering.

Wrap-Up

How do you expect volunteering with Crisis Intervention Services to impact your life?

What are one or two things you hope to gain from this experience?

Volunteer Commitment(Check all that apply)

 I HAVE received a copy of the current training schedule and will be able to attend all dates and times listed.

 I have reviewed the current training schedule and will be unable to attend the specified training date for the following reason:

Date______Reason______

 I have NOT received a copy of the current training schedule but have listed the dates I am unavailable during the

general training period on the back of this commitment.

 I plan to volunteer for TEENline and will be able to work either one 2-hour shift each week or one 4-hour shift

every other week.

 I plan to volunteer for CRISISline and will be able to work one 3- or 4-hour shift each week.

 I believe that I will be able to maintain my position as a volunteer for one year.

______

Signature Date

Signing here does not legally bind you to a year of volunteer work with Crisis Intervention Services. Signing simply indicates a willingness to strive for a year of service. We will make all reasonable attempts to work with your other commitments.