Please fill out the following application and hit submit at the bottom of the page

Name
Street Address
City
State
Zip code
Email Address
Home telephone
Hours
Do you have a private number block on your home phone?	yes no
Work telephone
Hours
Best time to call
Past experience (education/training/work/volunteer, etc.)
Highest level of education completed
Current Employment
Student? yes no	Major
How did you hear about Response?
Please describe in detail your motivation to help others, including any personal life experiences or other information which may be relevant
If you have any limitations which would negatively impact on your volunteer work, please describe them (at this time, premises are not wheelchair accessible)
yes no If yes, please describe
The following is an exercise in empathy building, please complete each statement as clearly and as concisely as you can
People who attempt suicide are
Abortion, in my opinion, is
As far as I'm concerned, gay people should
Women remain in abusive relationships because
My greatest asset for becoming a telephone counselor is
If you are selected as a crisis counselor, will you be able to make a six month committment? yes no
Would you be able to work your four hour shift on a Saturday or Sunday afternoon? yes no
Would you be willing to work your four hour shift after midnight? yes no
Optional section : We use these for statistical only, but it would be helpful if you could complete this section too. Sex: male female Age: Date of birth
Please list three references: Name Relationship to you Phone number
Name Relationship to you Phone number
Name Relationship to you Phone number