Newsletter – Crisis Center of Central NH | 1-866-841-6229

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Street Address City State ZIP Code
- Availability*
  - Days (7a-7p)
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- What type of involvement are you interested in?*
  - Crisis Line
  - Hospital Advocacy
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  - Outreach
  - Office Time
- Education*
- Special Skills/Interests
- Experience with Crisis Situations*
- Reason for interest in volunteering with the Crisis Center*
- Have you ever been convicted of any crime:*
  - Yes
  - No
- Please Explain*
- Have you ever been reprimanded, disciplined in any way or dismissed as an employee or volunteer because of:*
  - Sexual Misconduct
  - Violent Conduct
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- Please Describe:*
- Do you have a problem with drugs and/or alcohol?*
  - Yes
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- Please Explain*
- Have you ever had a temporary or final domestic violence protective order against you?*
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- Date Range*
- Please Explain*
- Current Employer
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- Phone*
- Previous Employer
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All Organizations For Which You Have Previously Volunteered:
Please list 3 personal references that you have known for at least 2 years and that are not related to you:
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- I authorize the people and employees and officers of the places I have mentioned above to provide The Crisis Center of Central New Hampshire any information requested by the Center that may be required to arrive at a decision about my application to work as a volunteer.
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