Individual Volunteer Application

1. What's your contact information?

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Name:

 

 

 

 

       

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City/State/ZIP:

 

    

 

 

 

 

 

Date of Birth

 

 


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Question - Required - I am interested in the following volunteer opportunities. Check all that apply.
Please make at least 1 selection from the choices below.

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(Maximum response 255 chars, approx. 5 rows of text)

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Question - Required - I am available to volunteer on the following days:
Please make at least 1 selection from the choices below.

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Question - Required - I am available to volunteer during the following times:
Please make at least 1 selection from the choices below.

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(Maximum response 255 chars, approx. 5 rows of text)

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Question - Required - By selecting yes and submitting this application, I agree to the following:


 

Application Accuracy: The information provided on this application is accurate to the best of my knowledge and subject to verification by CitySquare (CS) and my failure to complete this information may directly affect completion of the application process. I hereby release and agree to hold harmless from liability any person or organization that provides information. In agreeing to these terms on this application, I affirm that the information I have given is true and correct.

Criminal Background & Reference Check: I understand that the completion of this form does not guarantee me status as a volunteer and that I must meet all stated conditions required of the volunteer position for which I am applying including a criminal background and reference checks and that this information will be used to determine my eligibility for a volunteer position with this organization. I also understand that as long as I remain a volunteer here, CS may repeat this criminal history check at any time.

Volunteer Handbook & Guidelines: In the event of my selection, I will comply with all rules and regulations as set forth by CS and agree to adhere to the CitySquare Volunteer Handbook and its guidelines. A copy of the handbook and guidelines will be provided upon request.

Photo Release: I permit CitySquare to use my testimony/experience, photos and/or videos for communications purposes free of compensation. This includes but is not limited to: use on their website and other online/ electronic mediums, written publications, videos, etc.

Code of Ethics: As a volunteer I realize that I am subject to a code of ethics similar to that which binds the professionals in the organization in which I will participate. In agreeing to serve, I will honor the goals, rules and regulations of the program, keep confidential matters confidential, and I will not discriminate against any client/neighbor on the basis of race, color, ethnicity, creed, sex, age, socioeconomic status, handicap, nationality, sexual orientation and gender identity, political belief, or religion. I will not report to any volunteer activity under the influence of alcohol or drugs. I will not maintain a relationship with any client that is solely personal in nature. I will not engage in sexual activity with clients. I will not accept payment from clients/neighbors for services performed, nor will I expect or encourage clients to express their gratitude or to acknowledge their dependency, destitution, or neglect. I will not provide financial assistance to CitySquare clients/neighbors. I will report any violation of the Code of Ethics to my Site Supervisor. Being eager to contribute all that I can to the goals of this program, I accept this code of ethics, to be followed carefully and cheerfully.

Confidentiality: As a volunteer of CitySquare, I acknowledge that during the course of my service I may have access to and use of CitySquare’s confidential and sensitive business, financial, technical, and proprietary information, documents, methods, practices, and procedures, as well as private information about employees, vendors, independent contractors, and third parties, in whatever medium in which it may exist, including oral, written, and electronic communications (collectively referred to as "Confidential Information"). "Confidential Information" also includes all documents, data, and work product, in whatever medium, created by me or any other person in connection with or relating to my assigned duties at CitySquare. I will not at any time use for my own benefit or divulge, furnish, or otherwise make available, either directly or indirectly, to any person, firm, corporation, or other entity, any Confidential Information. I will keep all Confidential Information strictly and absolutely confidential, and I will access, use, and disclose it only as required for the performance of my assigned duties at CitySquare.

Volunteer-at-will: I will immediately notify CitySquare of any breach of this Agreement or any use of or disclosure of Confidential Information not authorized by this Agreement. Nothing in this Agreement changes my status as a volunteer-at-will of CitySquare, and I understand that either CitySquare or I may terminate my volunteer relationship at any time, with or without cause.

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