Adult Volunteer Application Form

Tell us about yourself! Please write clearly and fill out the entire application. Thank you!

Date of Application: _

Name (First, Middle Initial, Last) _________________

Address _____________

City ____________ Zip Code

Home Phone ______ Cell Phone __

Email Address ____________

School or Place of Employment ______

Year or Position/Title ______

What are your interests and hobbies?

Do you speak any foreign languages? If so, please list:

How did you become interested in San Francisco Peer Court?

What qualities do you have that would make you a good Peer Court volunteer?

___

What do you hope to gain or learn from by being a Peer Court volunteer?

Have you ever been the victim of a crime? Yes ___ No

Have you ever been convicted of a misdemeanor or felony? _____ Yes ___ No

If so, what was the charge? (this information is completely confidential and will not be shared with anyone outside of the Peer Court staff)___________________________________________________________

_____ _

Have you ever had an adverse experience(s) or contact(s) with any law enforcement agency or the court

system? If so, please explain:

Please check the role(s) you would like to perform at Peer Court:

□ Case Manager □ Adult Advisor □ Defense Attorney Mentor

□ Prosecuting Attorney Mentor □ Other:

When are you available to volunteer for Peer Court?

When are you NOT available to volunteer? (i.e. days, hours, times of year)

References - Please do not list relatives

Name Phone

Address

Relationship to you

Name Phone

Address

Relationship to you

Emergency Contact:

Name Phone

Address

Relationship to You

I hereby certify that the information I provided in this application is true and correct. My signature authorizes San Francisco Peer Court. to contact my references and conduct a criminal records check.

Signature of Volunteer Date

Social Security Number: ________ ___ Date of Birth: __