Women’s Crisis Center Volunteer Application

Thank you for your interest in volunteering at Women’s Crisis Center!

Please complete the below application and submit it electronically (as an attachment) to Kira Petrykowski, Women’s Crisis Center Volunteer Coordinator, at .

Alternatively, the applicationmay be printed, completed by hand, and faxed or mailed to Women’s Crisis Center’s Hebron location at (859) 655-2656 or 3580 Hargrave Drive, Hebron, KY, 41048, ATTN: Volunteer Services. Questions? Call (859) 750-1675.

Our Process and Requirements
Please note the requirements associated with each of the following volunteer roles at Women’s Crisis Center. Upon receipt of your application we’ll contact you to schedule an in-person interview and to discuss the next-available 40-hour hospital advocacy training series (where applicable). Don’t see a role that interests you? Call the Volunteer Coordinator to discuss options.
Hospital Advocacy
  • Submission of volunteer application
  • In-person interview
  • Reference check
  • Criminal background check
  • Successful completion of 40-hour hospital advocacy training series (offered several times yearly)
  • One-yearminimum commitment to serving the agency as a hospital advocate
  • Reliable transportation to local St. Elizabeth hospital locations (via personal vehicle)
  • Availability for at least two on-call shifts per month—including, at minimum, one p.m. (6 p.m. to 6 a.m.) shift
/ Community Outreach Team
  • Submission of volunteer application
  • In-person interview
  • Reference check
  • Criminal background check (where applicable)

Special Events Team
  • Varies by event

Front Desk Support (Hebron location)
  • Submission of volunteer application
  • In-person interview
  • Reference check
  • Criminal background check

Section A: Contact Information
Salutation: / First Name: / Last Name:
Home Phone (with Area Code): / Mobile Phone (with Area Code):
Email Address: / Street Number and Name:
City, State ZIP: / Birthdate:
Today’s Date:
Section B: Work Experience
Please include details for the 3 most recent positions you have held (begin with the most recent).
Work Experience I
Job Title: / Employer Name:
Employer Address:
Start Date: / End Date:
Work Experience II
Job Title: / Employer Name:
Employer Address:
Start Date: / End Date:
Work Experience III
Job Title: / Employer Name:
Employer Address:
Start Date: / End Date:
Section C: Educational Background
Please include details for the 3 most recent schools you have attended (begin with the most recent).
Educational Background I
Program of Study: / Institution Name:
Degree Attained:
Years Attended:
Educational Background II
Program of Study: / Institution Name:
Degree Attained:
Educational Background III
Program of Study: / Institution Name:
Degree Attained:
Years Attended:
Section D: Volunteer Experience
If applicable, please include details of your past (or current) volunteer roles, beginning with your most recent—or current—volunteer role.
Volunteer Experience I
Volunteer Title/Role:
Organization/Program Name:
Organization/Program Location:
Description of Duties:
Duration of Role:
Volunteer Experience II
Volunteer Title/Role:
Organization/Program Name:
Organization/Program Location:
Description of Duties:
Duration of Role:
Volunteer Experience III
Volunteer Title/Role:
Organization/Program Name:
Organization/Program Location:
Description of Duties:
Duration of Role:
Section E: Skills, Background, and Motives
In the box below each question, please indicate your response.
  1. Do you have any special skills or strengths—such as proficiency in a language other than English (including American Sign Language/ASL), or a background in social work, psychology, advocacy, teaching, writing, or public speaking—beneficial in a volunteer role at Womens’ Crisis Center?

  1. How did you become aware of—or engaged with—issues relevant to rape, sexual abuse, and/or domestic violence?

  1. Describe an occasion—in your workplace, volunteer, or social interactions—when you had the occasion to interact effectively and sensitively with members of diverse populations.

  1. How and where did you initially learn about Women’s Crisis Center’s volunteer opportunities and/or 40-hour hospital advocacy volunteer training?

  1. Please list areas of volunteer work that you would like to explore. Select from:
  2. Hospital advocacy (responding to survivors of rape, sexual abuse, and/or domestic violence who present in St. Elizabeth Hospital emergency departments in Northern Kentucky)
  3. Community outreach (staffing information tables/booths/exhibits during community events, or participating in a United Way campaign)
  4. Special events (providing onsite support—clerical, technical, etc.—at fundraising events
  5. Front desk support (answering phones and directing calls, greeting guests, and clerical/support tasks as needed at our administrative office in Hebron)

Section F: References
Please list names, phone numbers, number of years known, and, if applicable, organizational affiliations, for 3 individuals who have known you for at least 2 years.
Reference I
Salutation: / First Name: / Last Name:
Organizational Affiliation: / Years Known:
Telephone Number (with Area Code):
Reference II
Salutation: / First Name: / Last Name:
Organizational Affiliation: / Years Known:
Telephone Number (with Area Code):
Reference III
Salutation: / First Name: / Last Name:
Organizational Affiliation: / Years Known:
Telephone Number (with Area Code):
Section E: Emergency Contact
Please list name, relationship, and phone number(s) for one individual whom, in the event of a medical emergency, Women’s Crisis Center may contact on your behalf.
Emergency Contact I
First Name: / Last Name:
Relationship:
Primary Telephone Number (with Area Code): / Secondary Telephone Number (with Area Code):
Section F: Signature and Date
Please sign and date below.
Signature: / Date:

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