Date received: _____________

LGBT FOCUSED RESIDENCE

VOLUNTEER APPLICATION Name ________________________________________ Preferred ______________________ First Last Address _____________________________________________________________________ Street City State Zip Daytime Phone ________________________ Evening Phone _________________________ Email __________________________________________DOB_________________________ mm/dd/yyyy

Is it okay to leave a message at: The best way to contact me is

Home Phone

Work

Cell

Email

Email

Preferred Pronoun (i.e. he, she, ze, they, etc): _______ Emergency Contact: ______________________________ Phone _______________________ Are you a returning volunteer?

Yes

No

How did you hear about the Volunteer Program at Mary’s House for Older Adults, Inc.? ______________________________________________________________________________ _____________________________________________________________________________ Why do you want to volunteer at Mary’s House for Older Adults, Inc.? _____________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ Tell us about yourself. What do you feel makes you a good fit for Mary’s House for Older Adults, Inc.’s volunteer program? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Revised 01/14

Page 1 of 3

Which volunteer Committee/Activity are you interested in? (check all that apply) Web Development/Maintenance

Accounting

Property Maintenance

Marketing

Fundraising: Events

Major gifts

Planned Giving

Campaigns

Grants

Program Development

Special

In-kind support

Corporate

Public Relations

Federal

Pro Bono Professional Service Specialty: __________________________________

----------------------------------------------------------------

Administrative/Office

Volunteer Management

Risk Management

Community Outreach & Education

Building Contractors

Project Management

Architects

Policy

Real Estate

Grant Developer

DC Government

Do you have any past volunteer experiences? If so, please provide the name(s) of the organization(s) as well as a brief description of what you did. Organization

Position/Tasks

Dates

Do you have any other special skills or professional certifications that might benefit our clients or organization (i.e. Legal, Capacity Bldg., Marketing, Web, IT, etc.)? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Below, please list your general availability. Please remember that our volunteers are expected to commit to at least 4 hours per month. Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

When is the best time to reach you? We may have questions about your application or background check; let us know which of the following time frames is best to contact you. Wednesdays 10am – 12pm

Thursdays 10am – 12pm

Other _______________________________________________ Revised 01/14

Page 2 of 3

Time Commitment I understand that participation as a Mary’s House for Older Adults, Inc. Volunteer requires a minimum time commitment of four hours per month, and that I am to notify the Chair if and when I wish to discontinue volunteering with or without reason. _________ Initial Here

Insurance Information I understand that all volunteers must agree to allow Mary’s House for Older Adults, Inc. to run a base security check for insurance purposes. _________ Initial Here I understand that Mary’s House for Older Adults, Inc. does not insure drivers; my own insurance covers myself, my vehicle, my passengers, and all other damages during volunteer activities. _________ Initial Here

Confidentiality Statement I, _____________________________________________, am volunteering my time to work with Mary’s House for Older Adults, Inc. I understand that in the course of my volunteering I may learn information about an individual or the organization that is personal and confidential. Examples of such information include organizational strategies and finances, as well as individuals’ sexual orientation, economic status and relations with family/friends. I understand that all information must be treated as completely confidential. I agree not to disclose any information of a personal and/or confidential nature to any persons not affiliated with the Mary’s House for Older Adults, Inc. management without the specific written consent. I agree that if I have any doubt about a situation I will contact the President of Mary’s House for Older Adults, Inc.

_____________________________________________________ Signature

Revised 01/14

________________ Date

Page 3 of 3

MH Volunteer Application w background check and confidentiality ...

MH Volunteer Application w background check and confidentiality verbiage.pdf. MH Volunteer Application w background check and confidentiality verbiage.pdf.

118KB Sizes 1 Downloads 264 Views

Recommend Documents

Volunteer Criminal Background Check Form.pdf
Whoops! There was a problem loading more pages. Retrying... Whoops! There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Volunteer Criminal Background Check Form

Background Check Application (Construction) - Mansfield ISD
1) Go to this link: http://www.mansfieldisd.org/page.cfm?p=4516. ... 5) If fingerprinting is required, you will be notified by the Facility Department via email with.

Background Check Application (Construction) - Mansfield - Mansfield ...
Phone: 817.299.4343. 4) Once the application is approved by the Director of Facilities, the ... Primary Contact: ... DATE OF BIRTH. SOCIAL SECURITY NUMBER ...

Volunteer Confidentiality Agreement.pdf
Sign in. Page. 1. /. 1. Loading… Page 1 of 1. Page 1 of 1. Volunteer Confidentiality Agreement.pdf. Volunteer Confidentiality Agreement.pdf. Open. Extract.

Volunteer Application & Confidentiality Policy 10-15.pdf
SIGNATURE DATE. Please return this form to your student's school or to the. Clintonville Public School District Office. 45 West Green Tree Road, Clintonville, WI 54929. DISTRICT OFFICE USE: Background Check Ordered: ...

Volunteer Background Check.pdf
Whoops! There was a problem loading this page. Retrying... Whoops! There was a problem previewing this document. Retrying... Download. Connect more apps ...

MT - Fingerprint and Background Check Instructions.pdf ...
rolled ink transfer of prints onto a card. The ink method can have the highest rate of failure due to the. lower quality of print characteristics. However, some ...

Background Check Processing Flier.pdf
of Public Safety. 3. Court that Processed. Arrest. Confidentiality. Exceptions to the background investigation may be. granted, but not guaranteed, to former District employees. who have cleared a background investigation within the. past two years,

National Criminal History Background Check ... - Mansfield ISD
Bring it to the Maintenance/Facility Complex. 203 Hillcrest St. Mansfield, TX, 76063. Phone: 817.299.4343. 4) Once the application is approved by the Director of ...

National Criminal Background Check VENDOR ... - Mansfield ISD
Phone #: ______ ______ ______. City, State, Zip: ... Facility where Services will be Performed: (If multiple, state "Multiple") ...

Volunteer Application
Eve Phone: Nevada Drivers License #. ( ). ( ). Class: Exp. Date: Are you under age 18? _____YES. _____NO. Please answer the following questions.

empolyee background check authroization.pdf
... supervisor, private business, insurance company or. personal reference, and/or other persons to furnish any and all background information requested by BIB, ...

National Criminal Background Check VENDOR ... - Mansfield ISD
Complete one section below for each employee who will work on MISD campuses. (Attach additional sheet if necessary.) e-Mail Address: ...

eNLC Fingerprint Background Check Instructions.pdf
1) NAME: Type or print Last, First, Middle Name. Full name. is mandatory. You are encouraged to type, as it is easier to read typed. names. 2) AKA:Maiden name, other married names or any other. name used. 3) CITIZENSHIP: U.S. (If born US) Alien. Regi

National Criminal History Background Check Instructions ...
4) Once the application is approved by the Director of Facilities, the background verification will begin. 5) If fingerprinting is required, you will be notified by the ...

PI - Fingerprint and Background Check Instructions.pdf
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. PI - Fingerprint and Background Check Instructions.pdf. PI - Fingerprint and Background Check Instructions.p

PI - Fingerprint and Background Check Instructions.pdf
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. PI - Fingerprint ...

ARAMARK_NPO Background Check Authorization.pdf
I further authorize, without reservation, any person, entity or agency (including, but not limited to, criminal justice agencies, courts,. sex offender registries ...

National Criminal History Background Check Instructions ...
1) Go to this link: http://www.mansfieldisd.org/page.cfm?p=4516. Then select “Background ... days, at which time the applicant will be notified. If the applicant is ...

Equipment check-in volunteer sign up sheet
Equipment check-in volunteer sign up sheet. Date. Time. Parent Volunteer. Phone #s, home and cell. 12/4/2013. 12/11/2013. 7:50 AM Paula Mercer. 503-704- ...

PI - Fingerprint and Background Check Instructions.pdf
Fingerprint cards are provided. -OR-. Your local law enforcement agency. Contact the local law enforcement agency you will use and find out if they (a) use the.

criminal background check form for Scarlett and Mitchell - blank.pdf ...
Page 1. criminal background check form for Scarlett and Mitchell - blank.pdf. criminal background check form for Scarlett and Mitchell - blank.pdf. Open. Extract.

Volunteer Application Packet.pdf
at 823 W. Lacey Blvd., Hanford, is open during regular business hours from 7:30 a.m. – 4:30 p.m.. except holidays. Once you have received this Live Scan ...

Division of Real Estate Licensing Background Check Bulletin.pdf ...
Whoops! There was a problem loading more pages. Retrying... Division of Real Estate Licensing Background Check Bulletin.pdf. Division of Real Estate Licensing Background Check Bulletin.pdf. Open. Extract. Open with. Sign In. Main menu. Displaying Div