Dallas Pregnancy Resource Center : Partner Site

Year to Date Stats
Client Visits:	599
New Clients Seen:	291
Babies Saved:	27
New Believers:	7
Educational Class Visits:	166

Volunteer/Advocate Application

Basic Information

Your Name:
Address:
City / ZIP:
Phone:
Work:
Your Email Address:
Birthdate:
Date Available:
Which shift can you work?	Morning Afternoon Evening
Have you previously worked or applied at a pregnancy help center?	Yes No
If yes, give name of center and dates.
How were you introduced to the DPRC?
Marital Status Single Married Separated Divorced Widowed
Spouse’s Name
Spouse’s Occupation
Children:
Name:	Age:
Name:	Age:
Name:	Age:
Name:	Age:

Education

Name and address of School:
Major/Minor
Completed
Graduate School
Business/Technical
Other

Christian Commitment

Because DPRC is an interdenominational Christian organization, would you be willing to work and cooperate with other Christians whose doctrines may differ from your own?	Yes No
Have you trusted Jesus Christ as Lord and Savior?	Yes No
When?
Please describe your relationship with Jesus Christ:

Employment/Volunteer Record

List below three former employers and any organizations you have volunteered for during the previous five years beginning with the most recent or present. Former employers/organizations will be contacted if you and DPRC develop a strong mutual interest.

From: (mm/yy) To: (mm/yy)
Name of Organization
Address of Organization
Position Held
Name of Immediate Supervisor
Supervisor's Phone	###-###-####

From: (mm/yy) To: (mm/yy)
Name of Organization
Address of Organization
Position Held
Name of Immediate Supervisor
Supervisor's Phone	###-###-####

From: (mm/yy) To: (mm/yy)
Name of Organization
Address of Organization
Position Held
Name of Immediate Supervisor
Supervisor's Phone	###-###-####

From: (mm/yy) To: (mm/yy)
Name of Organization
Address of Organization
Position Held
Name of Immediate Supervisor
Supervisor's Phone	###-###-####

Personal

What is your family background?
How does your family/spouse feel about this kind of work?
What are your areas of strength?
Where do you need to improve?
Why would you like to be a DPRC volunteer?
Describe your emotional stability.
Have you ever had the opportunity to counsel a woman experiencing an unplanned pregnancy? Yes No If yes, please explain
Have you personally experienced an unplanned pregnancy? Yes No If yes, please explain
What are your views on abortion? Any exceptions?
What are your views on abstinence outside of marriage?
If you are single, do you practice abstinence?	Yes No
Briefly explain the plan of salvation.

Personal References

Please list three individuals (not related to you) who have knowledge of your personal abilities and character.

Name:
Address:
City / ZIP:
Phone:
Relationship:

Name:
Address:
City / ZIP:
Phone:
Relationship:

Name:
Address:
City / ZIP:
Phone:
Relationship:

Church Reference

Pastor's Name
Your Church
Church Address
City, State, ZIP
Phone
How long have you attended?
How are you involved at your church?

Criminal Record

Have you been convicted of any criminal offense in the last seven years?	Yes No
If yes, indicate the nature of the offense, date, court and disposition.

By submitting this form, I agree to the following:

I understand that the information I have provided may be verified, if necessary, by contacting persons named on this form. I agree to release from liability any person or organization that provides such information. I also understand and agree that DPRC may do further background checks on my personal driving record and criminal history (if any). I release DPRC from any responsibility of doing such a check. I understand that this information will be used to determine my eligibility for a volunteer position. I also understand that as long as I remain a volunteer here, they may repeat these driving and criminal background history record checks at any time. In submitting this form, I affirm that the information I have given is true and correct.

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