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Volunteer Application
Contact Information
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Eligibility Questions
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Volunteer Advocates must be at least 20 years of age
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Check all that apply.
Volunteer Requirements
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References
Please list three references (other than relatives or Ampersand Staff) that we may contact. One MUST BE a professional reference (e.g. present or previous supervisor, professor, etc.). Please provide the reference's name, relation to you, as well as a phone number or email they can be reached at.
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Certification of Applicant
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I certify that all answers to the questions in this application are true and I further understand that any false statement in this application will be sufficient grounds of rejection of the application or termination of employment/volunteer status without notice at any time hereafter.  I authorize Ampersand Sexual Violence Resource Center of the Bluegrass to complete a criminal background check if I have applied to a position subject to this requirement.  I understand that the findings of a record check may be grounds for rejection of application or termination of employment/volunteer status without notice.  I authorize the Ampersand Sexual Violence Resource Center of the Bluegrass to make all necessary investigations to verifying information contained herein, and authorize and release from liability and and all references to provide information relevant to my application for employment or volunteering. 

 

I certify that my elecronic signature is the equivalent of my manual signature on this document. 

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Application Submission Guidelines

After completing this application, you can expect to be contacted 1 to 2 weeks after submission.  If you have any questions about the application process, or about Ampersand Sexual Violence Resource Center, you may call our business line (859.253.2615) during regular business hours (Monday- Friday, 9am-5pm).