Date
Name
*
First
Last
*
Last
Email
*
Address
*
City
*
State
*
ZIP code
*
Are you a seasonal resident?
*
Yes
No
Typical residency dates in Naples (example: October to April)
Non-local address
City
State
Zip code
Phone (home) (cell)
*
Date of Birth
Driver's License Number (NA if you do not have a driver's license)
*
Emergency contact/relationship/phone
I would like to receive The Shelter's e-newsletter
*
Yes
No
Start Date
Number of hours of commitment per week:
Your preference for hours
Your preference for days
Which do yo prefer?
To be scheduled
To be on call
Choose areas of interest (* indicates additional training and background check may be required)
Administrative Support
Program-related Support
Naples Outreach Office Support
Immokalee Outreach Office Support
The Shelter Options Shoppe
Holiday help (Nov/Dec)
Be Salon (Licensed stylist)
*Kiddie Care Club/childcare
Emergency Shelter pantry and supply closets
Gardening
Education Background:
Current/Previous Occupations
Hobbies/Skills/Interests:
Current/Previous Volunteer Experience:
Are you multilingual? If yes, please list languages spoken
PERMISSION TO PERFORM BACKGROUND CHECK
*
Yes
No
I hereby allow SAWCC, Inc. to perform a check of my background, including: Criminal Record, Driving Record, Educational/Professional Status, Personal References. I understand that I do not have to agree to this background check, but that refusal to do so may exclude me from consideration for volunteering. I understand that information collected during this background check will be limited to what is appropriate for particular types of volunteer work. All such information collected during the check will be kept confidential. I hereby extend my permission to those individuals or organizations contracted for the purpose of this background check to give their full and honest evaluation of my suitability of the described volunteer work and such other information as they deem appropriate.
BACKGROUND CHECK ELECTRONIC SIGNATURE
*
DATE
*
CONFIDENTIALITY AGREEMENT (required)
*
Yes
No
Volunteer Ethics and Standards of Conduct Confidentiality Agreement Information received by The Shelter through files, reports, inspections, personal observations, interviews, or information regarding specific clients of The Shelter including information as to whether or not someone is a resident of The Shelter is confidential information and is prohibited from being revealed to anyone outside of the agency. No resident may be identified by name or distinguishing characteristics. In addition, communications regarding domestic violence incidents between The Shelter residents and counselors are privileged under state statue. Violation of client confidentiality is a violation of law, of our client’s rights, and of the agency ethical code. • I will be punctual and conscientious in the fulfillment of my duties and accept supervision graciously. • I will conduct myself with dignity, courtesy, and consideration. • I will consider all information that I may hear directly or indirectly concerning a client as confidential. • I promise to bring to my work an attitude of open-mindedness. I will be non-judgmental. I am willing to receive training and will show interest and attention. I will take any concerns or problems to my supervisor. • I will not participate in, condone, or be associated with dishonesty, fraud, deceit, or misrepresentation. • I will not practice, condone, facilitate or collaborate with any form of discrimination on the basis of race, color, gender, sexual orientation, age, religion, national origin, marital status, political belief, mental or physical disability, or any other preference of personal characteristic, condition, or status. Volunteers are expected to be tolerant of the opinions & conduct of others. • I will avoid non-professional relationships with participants or former participants outside of the work environment. I will not take participants or former participants or their children to my home. Prior relationships with participants must be reported immediately to my supervisor. I will not give gifts to participants or former participants. I recognize that our goal is to empower not rescue participants. I will make every effort to foster maximum self-determination of participants. • I will not accept or take gifts or contributions that are intended for participants or for the benefit of the agency. • I will not solicit funds, grants, or in-kind contributions without the approval of the CEO. • I will under no circumstances engage in physical or verbal abuse with participants, staff or other Volunteers. • I will respect the privacy of participants and hold in confidence all information obtained in the course of professional services. Volunteers are prohibited from discussing information about participants with persons other than staff directly involved with the participants or members of the management team. Participants confidentiality and privilege are outlined in state statue. Former Volunteers are obligated to maintain confidentiality and privilege of all communications with and about participants. Participant confidentiality is maintained even after a participant is deceased. • You are absolutely prohibited from unlawful manufacturing, distributing, possessing or using controlled or illegal substances or alcohol in the workplace.
CONFIDENTIALITY AGREEMENT ELECTRONIC SIGNATURE
DATE
*
What attracted you to The Shelter and how did you hear about us?
Do you have any physical limitations or are you under any course of treatment which might limit your ability to perform certain types of work?
If applying for an internship, what degree are you seeking and what school do you attend?
Have you ever had any personal experience with violence (answer only if you wish to do so)
NOTE
*The Shelter for Abused Women & Children Complies with section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 794, as implemented by 45 C.F.R. Part 84 (hereinafter referred to as Section 504) and the Americans with Disabilities Act of 1990, 42 U.S.C. 12131, as implemented by 28 C.F.R. Part 35 (hereinafter referred to as ADA)According to the requirements of Title VI of the Civil Rights Act of 1964, clients with limited English proficiency or hearing impairment have the right to receive FREE language interpretation, translation and other accommodations in order to access information and services, regardless of race, gender, country of origin, and religion. If you are in need of language assistance, including translation, interpretation or other accommodations, please let us know – this service will be provided to you at no cost. A TTY (Telecommunication Device for the Deaf) telephone line is available at The Shelter for residents who may be hearing impaired and Braille signage is used throughout the building.
Please list two non-family references who we might contact. Please list name and contact number.
reCAPTCHA (click to ensure website protection)
If you are human, leave this field blank.
Δ