Volunteer Application

Transcription

1 Volunteer Application 4940 Bayline Drive - North Fort Myers FL (239) , Extension (239) Fax

2 Dear Volunteer: Thank you for your interest in supporting Goodwill Industries of Southwest Florida. It would not be possible to accomplish our community s needs without the support of our volunteers. Please fill out the pages that follow and return the originals to our Administrative offices for processing. If you have any questions please feel free to contact me. For over a Century, Goodwill Industries has been helping individuals with disabilities and other disadvantages with the philosophy of a hand up, not a hand out. Dr. Edgar J. Helms, our founder, describes Goodwill as An industrial program as well as a social service enterprise a provider of employment, training and rehabilitation for people of limited employability, and a source of temporary assistance for individuals whose resources were depleted. Dr. Helms vision set an early course for what today has become an internationally known organization helping to enhance the dignity and quality of life of individuals, families and communities through the power of work! Sincerely, Natalie Stratta Volunteer Coordinator nataliestratta@goodwillswfl.org Phone: (239) , Ext 249

3 Volunteer Application Page 1 of 4 Please Print Date: Name: Mailing Address: Apt or Suite #: City: State: Zip Code: Home Phone: Cell Phone Business Phone: Address: Demographic Information: Date of Birth: Valid Driver s License? Yes or No State Do you speak another language, if so what? Are you a legal U.S. citizen? Yes or No Guardian: Phone *If under 18 years of age, please supply permission note from guardian and contact information. Special needs: Pursuant to the America for Disabilities Act, Do you require special aides or services? Yes No If yes, please explain: Name of person to contact in case of an emergency: Name: Relationship: Telephone Numbers to call: Day: Evening: How did you hear about our volunteer program? Please check which one applies: Goodwill News-Press Volunteer website Friend Social media Other: References: Please print the contact information for two people we may contact who have known you for more than two years. Name1: Relationship: Telephone: ( ) How long have you known this person? Name2: Relationship: Telephone: ( ) How long have you known this person? Information about your interests/skills/experience and availability: Please describe any specific interests/events you have:

4 Would you prefer to volunteer: Retail store Shipping Dept Events ALL Page 2 of 4 Other: Career Service Dept (Assist with resumes & job search) f Communications/PR/Marketing Please list any experience/skills you have relative to your interests: Please circle the best times you would be available to volunteer: Mornings: Monday Tuesday Wednesday Thursday Friday Saturday Sunday Afternoons: Monday Tuesday Wednesday Thursday Friday Saturday Sunday Evenings: Monday Tuesday Wednesday Thursday Friday Saturday Sunday Months: All Year Only during the following months: Counties: What county(s) are you available to serve: Lee Charlotte Hendry Collier Glades Background check: Have you ever been arrested or convicted of a crime? Yes No If yes, please explain: Volunteer Privacy Information and Release Authorization Application information I certify that all information in this application is true and complete. I understand that any false information or Omissions may disqualify me from further consideration for volunteer service and may result in my dismissal. Background investigation I understand that a background investigation will be conducted. Use of computers: I understand that during my time at Goodwill I am not allowed to access any computer unless I have been granted permission by the IT department, and after I have signed the IT policy.

5 Page 3 of 4 By my signature, I further understand and certify the following: Goodwill retains the right to drug test me for illegal substances The individuals/employer/references listed on the application are authorized to release information and verify information on this application. I will conduct myself in accordance with Goodwill Industries policies, rules and regulations (policy books are available for volunteers to review). If I am unable to attend my scheduled time, I will call and give as much notice as I can. Applicant Signature Date Guardian (if under 18 years of age) Date Please do not write below this line References done IT agreement signed Background check done Copy of Driver s Lic Info given on MENTOR program Established in SAGE Established in Volunteer CDS program Underage permission slip given Goodwill signature Date

6 Page 4 of 4 Volunteer Release Date: I,, am aware that volunteering for Goodwill Industries of SWFL, Inc. could involve risks of personal injury, property damage, and other risks associated with volunteer service. I RELEASE Goodwill Industries of SWFL, Inc., its employees, Boards of Directors, and organizers of the agencies events, from liability for any loss, damage, and claims, including attorney fees, on account of injury to me or my property arising directly or indirectly from volunteering. I HEREBY HOLD HARMLESS Goodwill Industries of SWFL, Inc. and project organizers from any and all claims, actions, or damages relating to or arising out of any activity related to volunteering for the agency. These releases are effective for personal representatives, my assigns, heirs, and me. I KNOW that if I become injured while participating in volunteer events, I am responsible for my healthcare expenses, and I have made arrangements to handle such expenses through insurance coverage, access to cash, or other methods. I ASSUME FULL RESPONSIBILITY FOR any and all claims and costs (including my own) arising directly or indirectly out of activities, acts, or omissions while volunteering with Goodwill Industries of SWFL, Inc. I FURTHERMORE give any organization involved with Goodwill Industries of SWFL, Inc., permission to photograph me. I understand that the organizations have permission to use these photographs/videotapes for publicity purposes, unless written notice is received to the contrary. I CERTIFY that the statements made in this volunteer release are true and correct, and have been given voluntarily. I understand that this information may be disclosed to any party, with legal and proper interest, and I release the agency from any liability whatsoever for supplying such information. I understand that I will not be paid for my services as a volunteer. I HAVE CAREFULLY READ AND UNDERSTAND COMPLETELY THE ABOVE PROVISIONS AND VOLUNTARILY SIGN THE RELEASE AND INDEMNITY AGREEMENT. PRINTED VOLUNTEER NAME: SIGNED VOLUNTEER NAME: DATE: GUARDIAN PRINTED NAME: GUARDIAN SIGNATURE: DATE: