VIBS Family Violence and Rape Crisis Center
Victims Information Bureau of Suffolk

P.O. Box 346
Central Islip, NY 11722
(631) 360-3730

Childcare Volunteer Questionnaire

Applicant Name: *
Date:
Address: *
Daytime Phone: *
Evening Phone: *
Emergency Contact Number: *
Email Address: *
How did you hear about this?:

1. Why do you want to volunteer for VIBS?

2. Have you volunteered anywhere else? If so, where, and what type of volunteer work did you perform?

3. Why are you interested in working with children?

4. What do you think your role can be in the lives of the children?

5. When are you available?

Do you have access to a reliable car?

7. Do you have any special skills? (e.g., languages spoken, computer literacy, etc…)?

8. Employment background

9. Educational background

10. Please list a person to contact in case of emergency:

Name:
Phone:

11. Please list the name(s) of anyone else you know of who may be interested in volunteering

12. Please list the names and numbers of at least two people who know about your work experience, especially that with children, so we can check references.

Victims Information Bureau of Suffolk operates from a position of respect for all of our clients, staff and volunteers regardless of: race, sexual orientation, ethnicity, religion, ability, age or gender. Any volunteer who shows intolerance to diversity will be immediately dismissed from the program.