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Application For Teenline Volunteer

Personal Info
Name

Address
Personal (Cell) Phone

Family (Home) Phone
Teen Email

Parent Email
Emergency Contact Name

Emergency Contact Phone
Gender 
M F		        Birth Date
Age
    Ethnicity (Optional)

 
School Info
 
School

 
School Phone
Grade
9 10 11 12		 Expected Graduation Date
Additional education/training

 
Family Info
 
Name & Ages of People You Live With & Their Relationship to You
 
First Listed Parent or Guardian
Name

Address
Occupation

Employer
Business Phone

Cell Phone
 
Second Listed Parent or Guardian
Name

Address
Occupation

Employer
Business Phone

Cell Phone

 
Experience Info
 
Hobbies, Interests & Skills
Current Employment Status
Fulltime Part-Time  Do Not Work  
Additional education / training
Name of Employer

Job Title
 
Previous volunteer experience including locations & dates
 
Explaining your interest in volunteering for Contact TeenLine
 
What are your strengths & limitations relating to people in distress or crisis


Background Verification
Have you ever been convicted of a criminal offense? Yes  No
Have you ever been charged with neglect, abuse, or assault? Yes  No
Has your driver’s license ever been suspended or revoked in any state?  Yes  No
Do you use illegal drugs? Yes  No
Do you have any physical limitations which might limit your ability to perform certain types of work? Yes  No
Background Checks will be performed before active service.

 
Availability & Commitment
Are you willing to commit to the full training class plus apprentice shifts followed by at least one year of service to ContactLifeline and monthly meetings? Yes  No
 
What form of transportation do you plan to use if you are accepted to Contact TeenLine?
All Teens are required to work at least one weekend night a month on the line. Please indicate if you are able to do this Yes  No

 
References
List name and phone numbers of three adult personal and/or professional references, such as a teacher, clergy, employer, or therapist:
 
Name

 
Phone
How many years known and in what capacity? 
 
Name

 
Phone
How many years known and in what capacity? 
 
Name

 
Phone
How many years known and in what capacity? 
 
Name

 
Phone
How many years known and in what capacity? 

  
Confidentiality Policy

Please read carefully. By clicking the I AGREE button below, you commit to the following statement.

Realizing that confidentiality is the cornerstone of the ContactLifeline program, I agree to keep any and all information that comes to me during training in the strictest of confidence.

I agree that I may be asked by the Program Director to withdraw from classes at any time.

I also agree that in the event of my withdrawal or resignation, I will keep confidential all information related to the work of the ContactLifeline Crisis Helpline.