Volunteer Application
Thank you for your interest in joining Haven Hills' team dedicated to breaking the cycle of domestic violence!
Please complete this form, and hit the "Submit" button at the bottom of the screen. You may also print the form and fax or mail it to Haven Hills, P.O. Box 260, Canoga Park, CA 91305. A Haven Hills representative will contact you to coordinate your volunteer involvement.
Name *
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Address *
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City *
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State *
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Zip *
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Phone *
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Work Phone
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Cell Phone
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Email *
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Date of Birth *
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Profession *
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Employer
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Title
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How did you hear about/were you referred to Haven Hills? *
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Why do you want to volunteer for a domestic violence program? *
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What do you expect to gain from your volunteer experience at Haven Hills? *
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Have you been in therapy? If yes, how long were you in therapy and how do you feel
about the experience?
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Have you ever been arrested? If yes, Please explain.
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Have you had any previous experience with domestic violence in any form (child abuse,
dataing violence, spousal abuse, etc.)? If yes, please describe. If you are a survivor,
how long have you been out of the relationship? *
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Have you, through personal experience, family, or friendships, experienced a crisis
or emergency situation? Please describe how you react or respond in an emergency
or crisis situation. *
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Please complete the following statements *
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People being abused by their partner are in need of
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As a person, I am
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As a volunteer at Haven Hills, I can
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I would like you to know that
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Areas of Interest
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Which of the following are you interested in volunteering with?
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Do you speak any languages other than English?
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Hours per week you are able to commit to volunteering *
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Best Times For You To Volunteer
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Is there anything else we should know about your application?
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Personal References Please list three people who are not related
to you that will be able to speak as personal references: *
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By submitting this form, I authorize Haven Hills to contact my references on behalf
of my application as a volunteer.
By submitting this form, I certify that the information on this application is true
and complete. I understand that misrepresented or false information will disqualify
me from the volunteer position I am seeking, or may be cause for dismissal after
my service begins. *
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* Denotes a required input.
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