Volunteer Application
Please complete and return to: 1800 Westchester BLVD.Springfield, Il. 62704
or E-Mail to
Name______Date______
Last First Middle Initial
Address______
Street City State Zip
Phone______
Home Work Cell
E-Mail______Best Way to Contact ___Phone ___E-Mail
Emergency Contact______Phone______
Name Primary Secondary
What types of volunteer work are you interested in?
Direct Service Indirect Service
_____Hotline _____Sojourn’s Westside Fashions
_____Group counseling _____Housekeeping
_____Court Advocacy _____Fundraising
_____Pro-Bono Legal Services _____Special One-Time Projects
_____Children’s Individual Counseling _____Clerical
_____Children’s Group Counseling _____Shelter Monitoring
_____Individual Counseling _____Providing Meals
_____Other
Please Note: Direct ServicesVolunteering requires a 40 hour domestic violence training which Sojourn provides. This training is required of anyone desiring an internship, or any volunteer position that works directly with clients or client records.
What days and hours would you be able to volunteer?______
How did you learn about Sojourn?______
What is your education and occupation?______
Have you ever been directly affected by domestic violence? _____Yes _____No
If yes, how long ago?______How was it resolved?______
Have you or anyone you know received services from Sojourn in the last two years?
______Yes ______No If yes, please explain______
Please feel free to give any additional comments or information that you think might be helpful or important for Sojourn to know about you______
Please Read Carefully, Initial Each Paragraph and Sign Below
_____ I understand that Sojourn staff and volunteers are legally mandated to report any
suspicion of child abuse/neglect to the Illinois Department of Children and Family
Services (DCFS). I also understand that Sojourn staff and volunteers are legally
mandatedto report Elder abuse.
_____I understand that Sojourn is a non-judgmentalagency and serves individuals from
different class backgrounds, ethnic/racial backgrounds, religious beliefs, and sexual
orientations. While serving as a volunteer, I understand that I must abide by Sojourn’s
code of ethics and philosophies.
_____I understand that I shall be asked to pass a criminal background check before taking the
40 hour domestic violence training or working directly with clients or client records. I
hereby authorize Sojourn Shelter & Services to investigate my references, work record,
education, criminal record, and other matters related to my suitability for a volunteer
position.
_____I hereby certify that I have not knowingly withheld any information that might adversely
affect my chances for volunteering and that the answers given by me are true and correct
to the best of my knowledge. I further certify that I, the undersigned applicant, have
personally completed this application. I understand that any omission or misstatement
of material fact on this application or on any document used to secure a volunteer position
shall be grounds for rejection of this application or for immediate discharge if I have been
selected to volunteer, regardless of the time elapsed before discovery.
Signature of Applicant Date
To be completed by SojournDate Application Sent______Date Application Received______
Interviewed By:______Date______
Criminal Background Check Required? Yes No
Date CBC sent off_____Date CBC returned_____ Result of CBC______
Approved as Volunteer Yes No If No, Explain______
Approved for Training Yes No If No, Explain______
Mandated Reporter Status Signed _____Yes _____No
Confidentiality Agreement Signed _____Yes _____No
Code of Ethics Signed _____Yes _____No
ER Contact Form Completed _____Yes _____No
Internet Agreement Signed _____Yes _____No
40 Hour Training Certificate _____Yes _____No
On the Job Training Checklist _____Yes _____No
Other:______