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SVdP CARES Community Service Application

Name *
Name
Address *
Address
Phone *
Phone
Date of Birth MO/Day/Year
Gender *
Has your license ever been suspended/revoked? *
Have you ever been convicted of a felony? *
Have you ever been a defendant in a civil action for an intentional tort (e.g. assault/battery)? *
Has your employment ever been terminated for reasons related to allegations of physical abuse? *
Volunteer opportunities *
What days of the week are you available?
Date *
Date