Restore Our Humanity’s primary focus on this initiative is to provide a safe place for all survivors to join, to talk, to be heard, and to be believed.

Volunteer Application

(must be at least 18 yrs. old)
Name:    
Cell:    
Email:    
Address:    
City:    
Zip:    
Have you volunteered before?
        Yes     No 
If yes, what type and where?
Preferred days and hours (typical shifts are 7-11, 9-1, 10-1, 2-5, 1-5, 5-8, 8-mid)
Days: (check all that apply) MON    TUE    WED    THU    FRI    SAT    SUN   
Hours: (check all that apply) 7-11     9-1     10-1     2-5     1-5     5-8     8-mid    
How long do you intend to volunteer? Six Months     Six to twelve months     One year or longer 
Desired activity level: Very Active     Moderately Active     Limitied Activity    
Desired Volunteer activity:  Taking calls from survivors: 
Co-facilitating a Survivor's Support Group: 
Clerical work: 
What specifically brought you to volunteer with us at this point in your life?

Are you currently employed? Yes     No      if yes, number of hours worked per week  
Name of Employer:     City:      Phone:  
Describe employment, school, or community experiences and skills applicable to volunteering:

Special skills,training, interests or hobbies (fund raising, event organizing, crafts, typing, music, foreign languages etc.)

Our goal is to match qualified applicants with available positions. If we do not call you at this time, we will keep your application on file. We will ask for personal references and a background check.
References: Personal or Professional (please exclude relatives)
Name:      Phone:     Relationship to you:  
Name:      Phone:     Relationship to you:  
Name:      Phone:     Relationship to you:  
Emergency Phone Numbers: (people to call in case of emergency)
Name:      Phone:  
Name:      Phone:  
Do you have any medical or psychological conditions of which we should be aware?

Background information
Have you been convicted of a crime and/or released from confinement following a conviction for any criminal offense?
Yes       No   
If yes, give date, place and nature of each such conviction.

Are you presently charged with any violation of the law?
Yes       No   
If yes, give date, place and nature of each such charge.

Add any additional comments or information you wish.

By submitting below, I understand that:

1. I am working with sometimes fragile people and will do all in my power to treat them with respect and dignity.
2. I am declaring that I am of sound mind and that my own mental health is stable and that I am capable of hearing about other’s traumas without judgement or invalidation. If I am triggered about my own issues, I will let the volunteer coordinator know ASAP and seek my own therapist assistance.
3. I authorize a reference and criminal background check, as well as an investigation of any and all statements contained in this application, for the purpose of determining volunteer decisions.
4. In the event of acceptance into the volunteer program, it is my responsibility to read the rules and regulations of ROH volunteer assignment, and. I agree to abide by these rules and regulations and to perform my assigned volunteer duties to the best of my ability. If I cannot perform essential duties and requirements, I will notify the volunteer coordinator immediately or request reasonable accommodations in performing essential functions of this position.
5. Volunteers are considered a member of our ROH family, and as such have a certain responsibility to ROH and its staff and survivors; to observe the same level of ethics, to adhere to ROH policies and procedures, and to uphold survivor confidentiality.
6. Before beginning an active volunteer assignment, I will be required to:
____ complete a criminal background check
____ meet with Volunteer Coordinator Shelly Eyre, LCSW or Karen Crist, LCSW
____ Volunteer orientation and training
____ Be available for at least one 2-5 hour shift a week (on call).