VOLUNTEER APPLICATION

Transcription

1 Tr. Ltr. Sent Tr. Ltr. Gave VOLUNTEER APPLICATION The Dumb Friends League encourages the participation of volunteers who support the following mission: to provide shelter and care for animals; to provide programs and services that enhance the bond between animals and people; to be advocates for animals speaking for those who cannot speak for themselves. All potential volunteers must be interviewed prior to placement. We also require that all volunteers participate in our training program as part of their work experience. If you agree with our mission and are willing to be interviewed and trained, we encourage you to complete this application. The information on this form will help us find the most satisfying and appropriate job for you. Please print your responses. Date: Name: Title First Middle Last Nickname Birth date: (Month) (Day) (Year) Address: City Zip Home Phone # Work Phone # Cell # Emergency # Name: Relationship: ( is used for correspondence with the Volunteer Services department and your home department. If requested, we will also you the VIP newsletter and League Mews, our electronic newsletter.) Education: High school College Graduate school Name of school/college: Are you presently employed? Yes No If yes, state your work schedule:

2 Employer s name and address: Industry: Position: Profession: Previous work experience: Special skills, training, interests or hobbies: What kind of volunteer job are you currently interested in? At which shelter are you interested in volunteering? Quebec Buddy Center Are you available regularly each week? Yes No Please indicate the times you would be available for work: Monday Tuesday Wednesday Thursday Friday Saturday Sunday Almost Any Time How did you hear about our volunteer program? Why are you interested in becoming a volunteer at the Dumb Friends League? Describe any previous experience working with animals: Describe present and previous volunteer jobs:

3 We would be interested in any further information you might wish to offer: Please list two references who are not family members: Name Relationship Phone Number Name Relationship Phone Number I give my permission to the Dumb Friends League to verify any of the information given. X (Volunteer signature) I wish to receive VIP, the volunteer newsletter via . I wish to receive League Mews, the electronic newsletter of the Dumb Friends League Department use: new volunteer information Volunteer s Name: Specific Dept. Trng. Interview Date: Placement: Date: Training Date: Shift: Time: Interviewer: Start Date: Trainer:

4 Types of animals you are able to foster (check all that apply): HOMES WITH HEARTS FOSTER CARE APPLICATION Adults (6 mo+): Cats Dogs Small Mammals Birds Individual or Litters: Kittens Puppies Small Mammals Birds Adults with Litters: Feline Canine Small Mammals P# What types of problems are you willing to work with (check all that apply)? Behavior Socialization Health Orthopedic Why do you want to foster? What previous pet experience, if any, do you have? Do you have children? Yes No If so, what are their ages? Do you presently have pets in your home? Yes No If yes, how many? What types? (List breed, age, and sex) Are they spayed or neutered? Yes No Do any of your current pets have behavioral concerns or chronic illnesses? Please explain: Are your animals vaccinations current? Please describe the area where the foster animal will be cared for: Do you have a fenced yard? Will you isolate the foster animals from your own animals? Yes No How will they be isolated? Will the foster animals be housed indoors? Yes No If not, please explain: How many hours will the fosterlings be left alone? Who, if anyone, will assist you in caring for the animals?

5 VOLUNTEER AGREEMENT By signing below, I hereby accept a position as a volunteer for the Dumb Friends League, upon the following terms, conditions and understandings: Terms and Conditions 1. My services are provided strictly in a voluntary capacity as a volunteer, and without any express or implied promise of salary, compensation or other payment of any kind whatsoever. 2. My services are furnished without any employment-type benefits, including employment insurance programs, worker s compensation accrual in any form, vacations or sick time. 3. I will familiarize myself and comply with the League s policies and procedures applicable to volunteers. In particular, I fully understand that the League expects high standards of moral and ethical treatment of the animals under its care. I will adhere strictly to these standards in my capacity as a volunteer. 4. I understand that the League, without notice or hearing, may terminate my services as a volunteer at any time, with or without reason. Release 1. I understand that the handling of animals and other volunteer activities may place me in a hazardous situation and could result in injury to me or my personal property. On behalf of myself, and my heirs personal representatives and assigns, I hereby release, discharge, indemnify and hold harmless the Dumb Friends League and its directors, officers, employees and agents from any and all claims, causes of action and demands of any nature, whether known or unknown, arising out of or in connection with my volunteer activities. 2. Understanding that public relations is an important part of a volunteer s activities, I hereby authorize the Dumb Friends League to use any photographs of me in its possession for public relations purposes. I ask that the League use reasonable efforts to give me advance notice of any such use, but such notification is not a condition to release photographs for public relations purposes. Date Signature of Volunteer Signature of Dumb Friends League Representative If you are under 18, we must have your parent or legal guardian s signature below. PARENT OR LEGAL GUARDIAN (OF VOLUNTEERS 17 AND YOUNGER) As a parent or legal guardian of the above-named volunteer, I hereby give consent for my child or ward, as the case may be, to become a volunteer for the Dumb Friends League as described in the above Volunteer Agreement and, by the signature below, join in and agree to be bound by the terms and conditions of the above Release. Date Parent or Legal Guardian

6 FAIR CREDIT REPORTING ACT DISCLOSURE AND AUTHORIZATION - VOLUNTEER As an applicant for volunteering or as a current volunteer of the Dumb Friends League, you are a consumer with rights under the Fair Credit Reporting Act. When any of the following circumstances exist, the Dumb Friends League may choose to obtain and use information contained in either a consumer report or an investigative consumer report from a consumer reporting agency about you: (1) When considering your application for volunteering, (2) When making a decision whether to offer you a volunteer position, (3) When deciding whether to continue your volunteering, or (4) When making other related decisions directly affecting you. For explanation purposes, a consumer reporting agency is a person or business which, for monetary fees, dues, or on a cooperative nonprofit basis, regularly assembles or evaluates consumer credit information or other information on consumers for the purpose of furnishing credit reports to others, such as the Dumb Friends League. A consumer report means any written, oral or other communication of any information by a consumer reporting agency bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing your eligibility for employment purposes. An investigative consumer report means a consumer report or portion thereof in which information on your character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with your neighbors, friends, or associates reported on or with others with whom you are acquainted or who may have knowledge concerning any such items of information. In the event that an investigative consumer report is requested by the employer, you may within a reasonable time request additional disclosures regarding the nature and scope of the investigation requested as well as a written summary of your rights under the Fair Credit Reporting Act. The Dumb Friends League will request an investigative consumer report (criminal background check). By signing below, I, hereby voluntarily authorize the Dumb Friends League to obtain either a consumer report or an investigative consumer report about me from a consumer reporting agency and to consider this information when making decisions about my volunteering at Dumb Friends League. I understand that I have rights under the Fair Credit Reporting Act, including the rights described above. I further understand that the following personal identifying information is required in order to complete the background check and that I am providing it voluntarily and solely for this purpose. Social Security Number Date of Birth Signature Date If you are under 18, we must have your parent or legal guardian s signature below. As a parent or legal guardian of the above named volunteer, I hereby give consent for the Dumb Friends League to request a criminal background check for my child/ ward in conjunction with his/her volunteering commitment at the Dumb Friends League.

7 Parent or Legal Guardian Date A Summary of Your Rights Under the Fair Credit Reporting Act The Federal Fair Credit Reporting Act (FCRA) is designed to promote accuracy, fairness, and privacy of information in the files of every Consumer reporting agency (CRA). Most CRAs are credit bureaus that gather and sell information about you such as if you pay your bills on time or have filed bankruptcy to creditors, employers, landlords, and other businesses. You can find the complete text of the FCRA, 15 U.S.C u, at the Federal Trade Commission s web site ( The FCRA gives you specific rights, as outlined below. You may have additional rights under state law. You may contact a state or local consumer protection agency or a state attorney general to learn those rights. You must be told if information in your file has been used against you. Anyone who uses information from a CRA to take action against you such as denying an application for credit, insurance, or employment must tell you, and give you the name, address, and phone number of the CRA that provided the consumer report. You can find out what is in your file. At your request, a CRA must give you the information in your file, and a list of everyone who has requested it recently. There is no charge for the report if a person has taken action against you because of information supplied by the CRA, if you request the report within 60 days of receiving notice of the action. You also are entitled to one free report every twelve months upon request if you certify that (1) you are unemployed and plan to seek employment within 60 days, (2) you are on welfare, or (3) your report is inaccurate due to fraud. Otherwise, a CRA may charge you up to eight dollars. You can dispute inaccurate information with the CRA. If you tell a CRA that your file contains inaccurate information, the CRA must investigate the items (usually within 30 days) by presenting to its information source all relevant evidence you submit, unless your dispute is frivolous. The source must review your evidence and report its findings to the CRA. (The source also must advise national CRAs to which it has provided the data of any error.) The CRA must give you a written report of the investigation, and a copy of your report if the investigation results in any change. If the CRA s investigation does not resolve the dispute, you may add a brief statement to your file. The CRA must normally include a summary of your statement in future reports. If an item is deleted or a dispute statement is filed, you may ask that anyone who has recently received your report be notified of the change. Inaccurate information must be corrected or deleted. A CRA must remove or correct inaccurate or unverified information from its files, usually within 30 days after you dispute it. However, the CRA is not required to remove accurate data from your file unless it is outdated (as described below) or cannot be verified. If you dispute results in any change to your report, the CRA cannot reinsert into your file a disputed item unless the information source verifies its accuracy and completeness. In addition, the CRA must give you a written notice telling you it has reinserted the item. The notice must include the name, address and phone number of the information source. You can dispute inaccurate items with the source of the information. If you tell anyone such as a creditor who reports to a CRA that you dispute an item, they may not then report the information to a CRA without including a notice of your dispute. In addition, once you ve notified the source of the error in writing, it may not continue to report the information if it is, in fact, an error. Outdated information may not be reported. In most cases, a CRA may not report negative information that is more then seven years old; ten years for bankruptcies. Access to your file is limited. A CRA may provide information about you only to people with a need recognized by the FCRS usually to consider an application with a creditor, insurer, employer, landlord, or other business. Your consent is required for reports that are provided to employers, or reports that contain medical information. A CRA may not give out information about you to your employer, or prospective employer, without your written consent. A CRA may not report medical information about you to creditors, insurers, or employers without your permission. You may choose to exclude your name from CRA lists for unsolicited credit and insurance offers. Creditors and insurers may use file information as the basis for sending you unsolicited offers of credit or insurance. Such offers must include a toll-free phone number for you to call if you want your name and address removed from future lists. If you call, you must be kept off the lists for two years. If you request, complete, and return the CRA form provided for this purpose, you must be taken off the lists indefinitely. You may seek damages from violators. If a CRA, a user or (in some cases) a provider of CRA data, violates the FCRA, you may sue them in state or federal court. The FCRA gives several different Federal agencies authority to enforce the FCRA: For Questions or Concerns Regarding: Please Contact: CRAs, creditors and others not listed below Federal Trade Commission Consumer Response Center - FCRA Washington, D.C National banks, federal branches/agencies Office of the Controller of the Of foreign banks (word National or Currency/Compliance Management Initials N.A. appear in or after bank s Mail Stop 6-6 name) Washington, D.C Federal Reserve System member banks Federal Reserve Board (except national banks, and federal Consumer and Community Affairs branches/agencies of foreign banks) Washington, D.C Savings associations and federally Office of Thrift Supervision Chartered savings banks (word Federal Consumer Programs Or initials F.S.B. appear in federal Washington, D.C Institution s name) Federal credit unions (words Federal National Credit Union Admin. Credit Union appear in institution s 1775 Duke Street name) Alexandria, VA State-chartered banks that are not Federal Deposit Insurance Corp. members of the Federal Reserve System Division of Compliance & Consumer Affairs Washington, D.C FDIC Air, surface, or rail common carriers Department of Transportation Regulated by former Civil Aeronautics Office of Financial Management Board of Interstate Commerce Commission Washington, D.C _ Activities subject to the Packers and Department of Agriculture Stockyards Act, 1921 Office of Deputy Administrator - GIPSA Washington, D.C