Helping Hands Oak Park Church of Christ Volunteer Application

Personal Information

Name

Address

This address will receive a confirmation email

Phone

Personal History

Previous work or volunteer experience

Emergency Contact

Preferred volunteer day (Helping Hands Program)

Wednesday Thursday Both

Preferred volunteer day (other than HH Program)

Monday Tuesday Friday Saturday Sunday

Do you own or have access to a truck and maybe willing to perform item pick up duties? (For Helping Hands Program)

Yes No

Confidential Information

In order to provide a safe and secure environment, we believe it is necessary to include the following questions as part of our application process. All information will be kept confidential. (Police may access this information, under warrant, if requested.) Answering yes to any of the questions may not necessarily preclude your involvement in volunteering. Thank you in advance for your understanding.

Are there any circumstances involving your lifestyle or background that would call into question your ability to work with Children, Youth and Vulnerable Adults? (e.g. use of illegal substances, etc.)

Yes No

Have you ever been convicted or found guilty of a criminal offense for which a pardon has not been granted (excluding minor traffic violations)?

Yes No

If yes, please list offence(s) and the date(s) of conviction:

Have you ever been expelled from or had your employment terminated by any organization or employer for assault, violence or impropriety against a Child, Youth or Vulnerable Person (e.g. senior citizen or person with disabilities)?

Yes No

Have you ever been a defendant or respondent in a civil lawsuit or human rights complaint or other legal proceeding in which you were alleged to have abused or engaged in violence, harassment or other immoral or illegal behaviour or conduct involving Children, Youth or Vulnerable Adults?

Yes No

Do you have any health concerns which could impact your ability to perform the functions of the volunteer position for which you are applying? (Please note such health concerns may not prevent you from holding the position for which you have applied)

Yes No

Do you have any contagious diseases or conditions of which we should be aware, and which we may need to take steps to protect against transmission should you volunteer at our organization?

Yes No

If you have answered yes to any of the above questions, please explain.

References

Please provide the name of two individuals, excluding relatives, who could provide a reference for you.

Name of Reference

Phone Number

Nature of Relationship

Name of Reference

Phone Number

Nature of Relationship

Release of Information and Declaration of Intent

I hereby give Oak Park Church of Christ permission to contact the persons named as references to ascertain my suitability for a volunteer role. I release all such references from liability for any damage that may result from furnishing such evaluations to you.

I give Oak Park Church of Christ consent to verify the information provided herein and to contact the references listed. I waive any right to confidentiality and of any right to pursue damages against Oak Park Church of Christ for losses caused by the reference’s response.

I also grant my permission for Oak Park Church of Christ to perform a police records check, for purposes of my protection against any false allegations and for the protection of those I serve. I consent to such an investigation with the understanding that the results will be kept in strict confidence. I agree to adhere to the protection policies as adopted by Oak Park Church of Christ.

I understand that if my character or morals are deemed by Oak Park Church of Christ leadership to be inappropriate and/or criminal at any time during my volunteer service, Oak Park Church of Christ will be entitled to terminate my assistance without express cause or prior notice regardless of any other oral or written statement by Oak Park Church of Christ prior to, at, or following the date of volunteer service.

I will cooperate fully with the staff in the fulfillment of my duties and will keep all information I encounter, in my role as a volunteer, confidential.

I hereby acknowledge that, to the best of my knowledge, the information contained in this application for volunteering is true and correct.

Please Select

I agree I disagree

Please type your name to sign

Information received is confidential and is being gathered for the purposes of screening Program Personnel.

Ministry Personnel Agreement Form and Covenant of Care

I have read, understand and agree to comply with all the policies and procedures of Oak Park Church of Christ to protect the health and safety of Children, Youth and Vulnerable Adults at all times.

I also acknowledge the importance of safeguarding in all respects all of those to whom we minister especially Children, Youth and Vulnerable Adults by:

• Following all of the directives of the policies;

• Complying with the information given in my training orientation;

• Using appropriate language;

• Showing no bias on account of gender, ethnic background, skin colour, intelligence, age, religion, socio-economic status; and

• Respecting confidentiality and privacy, unless a Child, Youth, or Vulnerable Adult is in danger, in which case I will notify the police or other appropriate civil authority.

Please Select

I agree I disagree

Please type your name to sign

Confidentiality Agreement

I understand that I will obtain or have access to sensitive and confidential information in my role as an volunteer with Oak Park Church of Christ. That confidential information may include, without restriction, personal information regarding employees, volunteers, members, attendees, supporters or persons assisted by Oak Park Church of Christ including information in relation to donations, personal or family matters, or obtained from background screening of prospective employees or volunteers. I agree to maintain strict confidentiality of all such confidential information and I will not disclose such information to anyone (including to employees, volunteers, members, attendees, supporters, persons assisted, or my spouse or family members) except authorized representatives of Oak Park Church of Christ who need to know such information or as required by law. I understand and agree that confidentiality is very important in my role and critical to the effective functioning of Oak Park Church of Christ. If I become aware that any confidential information was improperly disclosed, I will immediately advise the Senior Pastor of Oak Park Church of Christ.

Please Select

I agree I disagree

Please type your name to sign

Helping Hands Oak Park Church of Christ Volunteer Application

Description

Please Fix the Following