Training Class Registration Training Class Registration Personal Information Name * First Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Phone Number * Email * How did you hear about the hotline? * Employment Information Employer * Or enter Not Applicable Occupation * Or enter Not Applicable Work Number May we contact you at work? * Yes - Best time to call?Yes - Best time to call? No Are you a student? * Yes - What year & field of study?Yes - What year & field of study? No Previous/Related Experience Any prior counseling experience? * Yes No If yes, what type? * Hotline Face to Face OtherOther Not Applicable Please list any previous or related expereince you might have. Please include any paid or volunteer work you've done. * Have you ever applied to CCSI before? * Yes - Indicate when:Yes - Indicate when: No Are you able to make a one (1) year commitment? * Yes No Are you able to participate in an initial 36-hour training class? * Yes No Are you able to work a three (3) hour shift each week? Shifts are discussed and scheduled during training. Yes No Please write a short statement about why you would like to volunteer for the hotline. * Previous/Related Experience - Continued It is necessary to ask the following questions since working in a crisis setting can sometimes evoke feelings of anxiety and emotional strain. If you are in counseling, we suggest that you consult your therapist before applying. We strive to promote the best mental health for both callers and counselor. Have you seen a therapist within the last three (3) years? * Yes No May we contact the therapist? * Yes No Therapist Name * Therapist Number * Have you ever used the services of Community Crisis Services? * Yes No Has suicide ever affected you personally? * Yes No If suicide has affected you personally, please tell us how. * References Please list two non-family members for references. Reference 1 Name * Reference 1 Address * Reference 1 Address Reference 1 Address Reference 1 Address City City State/Province State/Province Zip/Postal Zip/Postal Reference 1 Number * Reference 1 Email Address * Reference 2 Name * Reference 2 Address * Reference 2 Address Reference 2 Address Reference 2 Address City City State/Province State/Province Zip/Postal Zip/Postal Reference 2 Number * Reference 2 Email Address * Acknowledgement/Signature There will be an orientation for Hotline in advance of training. There is an initial 36-hour training class over a three (3) week period and 4 two (2) hour quarterly training sessions per year to maintain counselor certification. You will be notified well in advance of those dates. Do you have reliable means of transportation? * Yes No Please list any special skills you might be interested in sharing. The information given is correct to the best of my knowledge and belief and does not knowingly contain any material misrepresentation of facts. I understand that any material misrepresentation of fact given by me shall be cause for rejection before appointment, or dismissal from Community Crisis Services, Inc. after appointment. I also authorize Community Crisis Services. to contact my references/therapist. Enter your full legal name below. * Date * Submit your application Captcha