Wildlife Transporter Application

I hereby certify that the facts set forth in this Application for Volunteer Services are true and complete to the best of my knowledge. I understand that if I am accepted, falsified statements on this application shall be considered sufficient cause for dismissal. I hereby authorize the Animal Services/the City of Lacey to conduct a thorough background investigation of my prior work history and to verify the information contained in this application as it relates to the position for which I am being considered.

This Agreement is made, by and between Animal Services, the City of Lacey (a political subdivision of the State of Washington) hereinafter referred to as the “City” and {name} hereinafter referred to as the “Volunteer."

PURPOSE: The purpose of this Agreement is to outline the responsibilities of Animal Services/the City in providing volunteer opportunities and to create an understanding between Animal Services/the City and the Volunteer.

This Agreement shall apply to persons voluntarily performing non-compensated services for Animal Services/ the City, including but not limited to, practical work experience, recreational programs, senior programs, police resource centers, and academic internships.

AGREEMENT FOR NON-COMPENSATED SERVICES: The Volunteer agrees to abide by all relevant Animal Services and City policies and procedures and to perform the volunteer services in a safe, responsible manner in accordance with the descriptions of service.

It is further understood that this Agreement shall not in any way constitute nor create an employer/employee relationship between Animal Services/the City and the Volunteer. Animal Services/the City shall not be responsible for, nor liable for, nor shall the applicant be eligible to receive, any compensation or benefits as a result of this Agreement EXCEPT for State Labor and Industries Industrial Insurance medical aid coverage.

Animal Services' Code of Conduct:

• In order to remain in good standing, I understand I am required to adhere to the Code of Conduct for Volunteers
• Bring my best skills and abilities to my volunteer work
• Exercise caution and common sense when dealing with shelter animals. Safety first for volunteers and for animals.
• Treat all animals with kindness and respect
• Support the mission, goals, and efforts of Animal Services with a positive attitude
• Approach my volunteer responsibilities with professionalism
• Promote goodwill by handling contacts with staff, other volunteers, and visitors in a spirit of courtesy and cooperation
• Remember that as a volunteer I am advocating for animals and Animal Services in the community
• Correct, when possible, misleading or inaccurate information and representations made by others concerning Animal Services policies, practices, and procedures
• Maintain confidentiality of all information I may receive while at the shelter, written or verbal, pertaining to animals or people
• Observe all safety and security rules in the performance of my volunteer job duties. Report all problems concerning animals, visitors, or the environment immediately
• Animal Services’ property, services, or supplies are not available for personal use. If in doubt, ask staff
• Become familiar with and abide by all policies/procedures in the volunteer handbook and any updates, postings, or handouts that are provided by Animal Services
• Avoid engaging in any conduct that could be perceived as a conflict of interest
• Contact the Volunteer Coordinator if there are any questions or concerns about Animal Services' policies, procedures, interpersonal communications, or my volunteer responsibilities
• Abide by the Policy on Discrimination, Harassment, and Sexual Harassment (see next paragraph)

POLICY ON DISCRIMINATION, HARASSMENT, AND SEXUAL HARRASSMENT:

Animal Services seeks to provide a welcoming environment for volunteers, employees, and the public. The Shelter takes the issue of harassment and discrimination very seriously. In accordance with City of Lacey policy, any form of harassment or discrimination on the basis of age, color, creed, disability, disabled veteran status, gender, marital status, national origin, race, religion, sexual orientation, or veteran status is not allowed and violations to this policy will be treated as a disciplinary matter. We will not tolerate behavior, comments, or slurs of a discriminatory, demeaning, and/or harassing nature by any volunteer or employee to or about any volunteer, employee, or the public.

Sexual Harassment
Sexual harassment consists of unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature if (1) submission to the conduct is in any way made a term or condition of employment; (2) submission (or rejection) is used as the basis for any employment-related decisions; or (3) the conduct has the purpose or effect of unreasonably interfering with work performance or creating an intimidating, hostile, or offensive work environment. Harassment of a sexual nature may include verbal behavior such as unwanted sexual comments, suggestions, jokes, derogatory references to sexual orientation, physical behaviors such as pats and squeezes, repeatedly brushing against someone's body or circulation or display of written or graphic material of a sexual nature.

Other Forms of Prohibited Harassment
Animal Services has a zero-tolerance policy for harassment, and we are committed to maintaining a work environment free from any form of harassment. This includes behavior or actions (including personnel actions) taken because of a volunteer or employee's age, color, creed, disability, disabled veteran status, gender, marital status, national origin, race, religion, sexual orientation, or veteran status. Also prohibited are offensive or derogatory comments and/or use of "slang" terms, circulation or display of graphic or written materials, that are derogatory to or stereotypical of a person because of their protected status such as race, age, etc., if the actions have the purpose or effect of unreasonably interfering with work performance or creating an intimidating, hostile, or offensive working environment.

Reporting
If a volunteer believes they are a victim of harassment, suspects another volunteer or employee of being a victim, or sees a volunteer or employee harassing another individual, please contact Animal Services’ Volunteer Coordinator, Shelter Manager, Executive Director, and/or the City's Human Resources Office at 360-491-3214 or 360-412-2884. The matter will be promptly investigated and appropriate action will be taken according to the nature and severity of the incident. Please note that any type of harassment, policy violations, and/or inappropriate conduct is grounds for immediate volunteer dismissal.

Protection Against Retaliation
Volunteers and employees are prohibited from taking retaliatory action against a volunteer or employee because he/she in good faith reports alleged harassment in accordance with the provisions of this policy. Anyone who believes they have been retaliated against should immediately report the matter to the Volunteer Coordinator, Shelter Manager, Executive Director, and/or the City's Human Resources Office.

BACKGROUND CHECKS: I consent to Animal Services/the City performing a background check into my history in accordance with RCW 43.43.830–839 and waive any right of privacy I may have in such information for the limited purpose of Animal Services/the City considering it for determining my suitability as a volunteer. (To be used for volunteers who will have unsupervised access to children, developmentally disabled persons, or vulnerable adults or who will be working with confidential information.)

TERMINATION: I understand that I or Animal Services/the City may terminate this agreement at any time without cause and that I am volunteering my services at will and may be asked to discontinue such without prior notice or reason.

WAIVER & HOLD HARMLESS: I am fully aware that the work associated with being an Animal Services/City Volunteer involves certain risks of physical injury or death. Being fully informed as to these risks and in consideration of my being allowed to participate in Animal Services/the City’s Volunteer Program, I hereby assume all risk of injury, damage, and harm to myself arising from such activities or use of Animal Services/City facilities. I also hereby individually and on behalf of my heirs, executors and assignees, release and hold harmless Animal Services/the City, its officials, employees and agents and waive any right of recovery that I might have to bring a claim or a lawsuit against them for any personal injury, death or other consequences occurring to me arising out of my volunteer activities.

LIABILITY COVERAGE: I understand that Animal Services/the City is self insured through the Washington Cities Insurance Authority (WCIA) for liability coverage. Volunteers performing within the scope of their assigned duties as authorized by Animal Services/the City are afforded the same coverage as Animal Services/City employees under Animal Services/the City’s liability coverage with WCIA. I am fully aware that a volunteer’s intentional misconduct is not protected or covered by Animal Services/the City or WCIA.

This agreement will be in effect for the duration of my volunteer services beginning {date}.

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I, {name}, hereby authorize Sound Screening Services, Inc. (“SSS”) and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report be generated for employment/ seasonal employment/volunteerism with the City of Lacey.

I have received and read a Notice and Disclosure and I understand that the scope of the consumer report and/or investigative consumer report may include, but is not limited to, the following areas: without limitation, information concerning: verification of social security number, criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions, motor vehicle records to include traffic citations and registration. I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me to or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources.

I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me to the City of Lacey or its agents. I further authorize the complete release of any records or data pertaining to me that the individual, company, firm, corporation, or public agency may have, including information data received from other sources.

I hereby release the City of Lacey, the Social Security Administration, and its agents, officials, representatives, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family, or associates because of compliance with this authorization and request to release. You may contact me as indicated below.

I understand that this authorization is not an offer for employment/seasonal employment/volunteerism by the City of Lacey and that any false or misleading information I have provided to SSS may result in a refusal to hire, promote, reassign, or continue employment; or accept as a volunteer.

I also understand this authorization automatically expires 90 days from the date executed below and that I have the right to revoke the authorization at any time provided I do so in writing.

City of Lacey reserves the right to refuse to consider any application unless all questions are answered completely and honestly.

 

By signing below I acknowledge the above information is accurate and that I have read and understand the disclosure(s) given to me.

City of Lacey, Washington Pre-Adverse Action Disclosure – Candidate’s Copy Background Check

PROCESS:

The City of Lacey (COL) and its designated agents and representatives may request of you to conduct a comprehensive review of your background causing a consumer report and/or investigative consumer report to be generated purposes.  This request will only be made if the position you are being considered for is designated to require a background check.

The consumer report/investigative consumer report may include, but is not limited to, the following areas:

Verification of social security number; current and previous residences; employment history including all personnel files; education including transcripts; character references; credit history and reports; criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; birth records; motor vehicle records to include traffic citations and registrations; and any other public records or to conduct interviews with third parties relative to your character, general reputation, personal characteristics or mode of living.

You will be asked to authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to you or the City of Lacey or its agents.  You further authorize the complete release of any records or data pertaining to you which the individual company, firm, corporation, or public agency may have, to include information or data received from other sources.

In addition to the above, you will be asked to release the City of Lacey, the Social Security Administration, and its agents, officials, representatives, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may, at any time, result to you, your heirs, family, or associates because of compliance with this authorization and request to release.

This authorization automatically expires 90 days from the date executed and you have the right to revoke this authorization at any time provided you do so in writing.

ADVERSE ACTION STATEMENT:

Findings of criminal and/or traffic convictions from the background check process may disqualify you for employment and/or volunteerism for that specific job classification or position with the City of Lacey based upon predetermined conviction hiring guidelines for the position.

Should this occur you will receive a letter form the City’s Human Resources Department.  The purpose of this letter is to inform you that based on the information, in whole or in part, the City of Lacey is unable to offer you employment and/or a volunteer opportunity at this time.  You will be provided a summary of your rights, along with a copy of the report.

SUMMARY OF RIGHTS

If after reviewing the report, (1) you believe that the information it contains is inaccurate and/or (2) you want to know what information contained in the report fall outside our new hire/volunteerism guidelines, contact the City of Lacey Human Resources Department, 420 College Street, Lacey, WA 98503:  Attention HR Analyst, or call (360) 491-3214, within five (5) days of the date of this letter.  Otherwise, we will assume you no longer wish to pursue employment and/or volunteerism with our agency.

At our request, this report was compiled and furnished to us by SOUND SCREENING SERVICES, INC., Attention: Compliance Officer, P.O. Box 111088, Tacoma, WA 98411-1088, Telephone:  (253) 472-7336.  Please understand that SOUND SCREENING SERVICES, INC. simply provided us with the report and did not recommend or in any other manner participate in our decision to take this adverse reaction.  Therefore, they will be unable to provide you with specific reasons as to why action was taken.

Under the provisions of the Fair Credit Reporting Act, as amended, you have the right to dispute directly with SOUND SCREENING SERVICES, INC., any information contained in this report.  Based on proper and accurate identification, you may request SOUND SCREENING SERVICES, INC. to reinvestigate specific items of information contained in the report which you maintain are inaccurate.  Under the provisions of the law, SOUND SCREEING SERVICES, INC. , must respond to your request for clarification of the specific data you are questioning within a reasonable time.

SOUND SCREENING SERVICES, INC.  reports information and data as it appears in the public record.  If you question centers around the data as it appears in the public record or you are alleging that the public record is incorrect, SOUND SCREENING SERVICES, INC. cannot change nor modify any part of the record.  SOUND SCREENING SERVICES, INC. will however identify the source of the information that appears in the report.  You must contact the court or other information repository to have the data in your file changed.

WASHINGTON STATE LAW NOTICES

WASHINGTON STATE: If the COL requests an investigative consumer report, you have the right, upon written request made within a reasonable period of time after your receipt of this disclosure, to receive from the COL a complete and accurate disclosure of the nature and scope of the investigation requested by COL.  You are entitled to this disclosure within 5 days after the date your request is received or the date the COL ordered the report, whichever is later. You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act, which is also set out below.

STATE OF WASHINGTON CONSUMER CREDIT REPORTING ACT

SUMMARY OF CONSUMER RIGHTS

The State of Washington Fair Credit Reporting Act (WFCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records).

Here is a summary of your major rights under the WFCRA. The WFCRA is modeled after the Federal Fair Credit Reporting Act. The same rights are provided under the Federal Fair Credit Reporting Act and you have received A Summary of Your Rights Under the Federal Fair Credit Reporting Act. You can get the complete text of WFCRA RCW 19.182, from the Washington Code Revisers Office, P.O. Box 40551, Olympia, WA, 98504, or online at http://apps.leg.wa.gov/rcw/default.aspx?cite=19.182&full=true#19.182.070.

• You must be told if information in your file has been used against you. If a person takes an adverse action against you that is based, in whole or in part, on information contained in a consumer report, that person must tell you, and must give you the name, address, and telephone number of the consumer You have a right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency, although medical information may be withheld and given directly to your medical provider. You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You will not be charged for:
  • a consumer report if a person has taken adverse action against you because of information in your credit report;
  • the reinvestigation of information you dispute; or
    • corrected reports resulting from the deletion of inaccurate or unverifiable information.
• In addition, you are entitled to one free consumer report every 12 months, upon request. You may be charged a limited fee for a second or subsequent report requested by you during a 12 month period.
• You have a right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and you notify the consumer reporting agency directly of the dispute, the consumer reporting agency will reinvestigate without charge and record the current status of the disputed information before the end of thirty business days, unless your dispute is frivolous.
• Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Upon completion of the reinvestigation, if the information you disputed is found to be inaccurate or cannot be verified, the consumer reporting agency will delete the information and notify you of the correction. If the reinvestigation does not resolve your dispute, you may file with the consumer reporting agency a brief statement setting forth the nature of your dispute. The statement will be placed in your consumer file and in any subsequent report containing the information you disputed.
• Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than ten years old.
• Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need – usually to consider an application with a creditor, insurer, employer, landlord, or other business. The WFCRA specifies those with a valid need for access.
• You must be notified if reports are provided to employers. A consumer reporting agency may not give out information about you to employers without your knowledge. A potential employer must make a clear and conspicuous disclosure in writing to you or obtain your consent before obtaining a report. A current employer may not receive a report unless it has given you written notice that consumer reports may be used for employment purposes.
• You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. You may elect not to receive unsolicited “prescreened” offers for credit and insurance by using the consumer reporting agency’s notification system to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-5-OPTOUT (1-888-567-8688).
• You may place a security freeze on your credit report. A security freeze prevents your credit file from being shared with potential creditors or insurance companies. You may request a security freeze by contacting us by phone at 1-800-831-2578, online by visiting https://personalreports.lexisnexis.com/contacts.jsp mail, or by mail by writing to the LexisNexis Consumer Center; ATTN: Security Freeze; P.O. Box 105108; Atlanta, Georgia 30348-5108. We may charge a fee for providing this service.
• You may be able to block information resulting from identity theft from appearing on your credit report. If you are a victim of identity theft, a consumer reporting agency must permanently block misinformation resulting from that theft from appearing on your credit report. You must provide the consumer reporting agency with a copy of a police report as evidence of your claim before it can place the block on your report.
• You may seek damages from violators. If a consumer reporting agency, or in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the WFCRA, you may be able to sue in state or federal court.

COMPLAINTS

Any complaints by consumers under state law may be directed to:

Office of the Attorney General - Consumer Protection Division

800 5th Avenue, Suite 2000, Seattle, Washington 98104-3188

Phone 1-800-551-4636 or (206) 464-6684, Statewide Toll-Free TDD: 800 276-9883, Fax (206) 389-2801

Complaints May Be Made Via U.S. Mail or E-Mail

Complaints: http://www.atg.wa.gov/FileAComplaint.aspx (Include your U.S. Mail address with any complaint.)

Website & Forms: http://www.atg.wa.gov/ 

 

A Summary of Your Rights Under the Fair Credit Reporting Act

The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to www.ftc.gov/credit or write to: Consumer Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.

You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment – or to take another adverse action against you – must tell you, and must give you the name, address, and phone number of the agency that provided the information.

You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if: a person has taken adverse action against you because of information in your credit report;

you are the victim of identity theft and place a fraud alert in your file;

your file contains inaccurate information as a result of fraud;

you are on public assistance;

you are unemployed but expect to apply for employment within 60 days.

In addition, by September 2005 all consumers will be entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.ftc.gov/credit for additional information.

You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender.

You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.ftc.gov/credit for an explanation of dispute procedures.

Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.

Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.

Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need -- usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access.

You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to www.ftc.gov/credit.

You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. Unsolicited “prescreened” offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-5-OPTOUT (1-888-567-8688).

You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.

Identity theft victims and active duty military personnel have additional rights. For more information, visit www.ftc.gov/credit.

States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. Federal enforcers are:

TYPE OF BUSINESS and CONTACTS:
Consumer reporting agencies, creditors and others not listed below: Federal Trade Commission: Consumer Response Center – FCRA, Washington, DC 20580 1-877-382-4357

National banks, federal branches/agencies of foreign banks (word "National" or initials "N.A." appear in or after bank's name): Office of the Comptroller of the Currency, Compliance Management, Mail Stop 6-6, Washington, DC 20219 800-613-6743

Federal Reserve System member banks (except national banks, and federal branches/agencies of foreign banks): Federal Reserve Consumer Help (FRCH), P O Box 1200, Minneapolis, MN 55480, Telephone: 888-851-1920, Website Address: www.federalreserveconsumerhelp.gov, Email Address: ConsumerHelp@FederalReserve.gov

Savings associations and federally chartered savings banks (word "Federal" or initials "F.S.B." appear in federal institution's name): Office of Thrift Supervision Consumer Complaints, Washington, DC 20552 800-842-6929

Federal credit unions (words "Federal Credit Union" appear in institution's name): National Credit Union Administration, 1775 Duke Street, Alexandria, VA 22314 703-519-4600

State-chartered banks that are not members of the Federal Reserve System:
Federal Deposit Insurance Corporation, Consumer Response Center, 2345 Grand Avenue, Suite 100, Kansas City, Missouri 64108-2638 1-877-275-3342

Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission: Department of Transportation, Office of Financial Management, Washington, DC 20590 202-366-1306

Activities subject to the Packers and Stockyards Act, 1921: Department of Agriculture