I verify that the number of people & gross household income selected above is accurate and that I have no other source of income.

Applicant Signature*      Date*   

TRAINEE AGREEMENT & PROGRAM POLICIES:
I AGREE TO THE FOLLOWING POLICIES & EXPECTATIONS (initial on the line if you agree):

• I understand that the City of Good Workforce Development Program is a simulated work experience and I agree to treat it as such.: initials*   
• I agree to attend all scheduled classes for the full duration and will endeavor to schedule appointments outside training hours.   initials*   
• I understand that for the health and safety of others, I will not attend training while ill. (See Exclusion Policy) I understand if I am absent due to illness or injury more than 2 consecutive days, I am required to get a doctor's note before returning to training.  initials*   
• I understand that a no-call/no-show is unemployable behavior. I understand that a no-call/no-show may result in dismissal from the program or other disciplinary action.  initials*   
• I agree to confront personal challenges and/or barriers.   intials*   
• I agree to accept instruction and feedback from the trainer and continually look for ways to improve my performance. initials*   
• I understand that disruptive, disrespectful, or threatening behavior is not acceptable and is cause for immediate dismissal from the program without prior notice.  initials*   
• I understand that City of Good is a drug and alcohol free environment. I agree to refrain from any substances that may impair my ability to work safely.   initials*  
• I understand if I am taking cold medicine or prescription medication that compromises my ability to focus and work safely, I will notify my trainer so alternate tasks may be assigned..   initials*   
• I understand if I quit or am dismissed from the program, my referring agency will be notified.   initials*   
• I agree to conduct myself in a manner that is consistent with City of Good's values of Gratitude, Engagement, Empowerment & Potential.   initials*   
  • Trainees will complete the work that is assigned with a positive attitude.  initials*   

I agree to follow the above policies and expectations for the City of Good Workforce Development Program. I understand the implications of not abiding by the above policies and expectations- any omission of facts or falsehoods presented can result in my immediate dismissal from the program. I also understand that these procedures are in place to help me develop my skills for the workforce.
Applicant Signature*   Date*   

RELEASE AND WAIVER OF LIABILITY
The Momentum Group DBA City of Good, a 501(c)(3) non-profit organization organized and existing under the laws of the State of Idaho, and its board of directors, officers, employees, volunteers, staff, other administrators, agents, and sponsors (all collectively referred to for purposes of this Release as “City of Good”). City of Good, conducts job training, development and placement for persons with barriers to employment.

Trainee freely and voluntarily, without duress, executes this Release under the following terms:

1. Waiver and Release. Trainee releases and forever discharges and hold harmless City of Good from any claim or liability that Trainee may have against City of Good with respect to any bodily injury, personal injury, illness, death or property damage that may result from participation in City of Good’s operations. Trainee also understands that City of Good does not assume any responsibility or obligation to provide financial or other assistance, including but not limited to: medical, health or disability insurance or care, in the event of injury, illness, death or property damage (see insurance requirements below).
2. Insurance. City of Gooddoes not carry or maintain, and expressly disclaims responsibility for providing any type of insurance, including but not limited to health, medical, disability, vehicle or liability insurance coverage for the Trainee. EACH TRAINEE IS EXPECTED AND ENCOURAGED TO CARRY APPLICABLE INSURANCE PRIOR TO TRAINING WITH CITY OF GOOD. The Trainee understands that the Trainee will be responsible (either covered by personal medical insurance, or personal finances) for any costs associated with a personal injury or illness.
3. Medical Treatment. Except as otherwise agreed to by City of Good in writing, the Trainee hereby releases and forever discharges City of Good from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during the Trainee’s time with City of Good.
4. Assumption of Risk. The Trainee understand that the Trainee’s time with City of Good may include activities that may be hazardous to the Trainee such working in a commercial kitchen with knives & equipment, etc. The Trainee hereby expressly and specifically assumes the risk of injury or harm in these activities and releases City of Good from all liability for injury, illness, death or property damage resulting from the activities of Create Common Good.
5. Compensation. The Trainee understands that City of Good is a training organization and that the Trainee is not acting as an employee of City of Good and will not receive compensation. Some exceptions may apply for qualifying trainees. Qualifying trainees must be approved prior to training start date.

By my signature below, I acknowledge that I have read the above, understand it, and agree to the terms.

Applicant Signature*      Date*   

PLEASE NOTE: If you are a client of the WCA, Faces of Hope, and/or a survivor of domestic violence concerned with protecting your anonymity, please select "I DO NOT CONSENT for City of Good to take my photo." and "DENY".

First Name*   Last Name*,   
I CONSENT for City of Good to take my photo.  I DO NOT CONSENT for City of Good to take my photo.*   

I, hereby   GRANT   DENY*   permission to City of Good to use photographic, audio or video footage of me for the following purposes: Social Media Content, Informational Pamphlets, Website Content, Program Awareness Initiatives, and Fundraising Marketing and Events.

I understand that the photographs and other footage may be used in print, online or other forms of media, including but not limited to, social media, newspapers, magazines, and television. I understand that my photograph or audio/video footage may be edited or altered in any way deemed appropriate by the organization or individual, and that I will not have any right to approve or disapprove of the changes.

I herby release City of Good and its agents, employees, officers, directors and all other persons or entities acting under its permission or authority, from any and all claims and liabilities arising from the use of my photograph or audio/video footage.

I acknowledge that I will not receive any compensation, royalties or other benefits for the use of my photograph or footage.

I represent that I am at least 18 years old and have read this release before signing. I fully understand the contents, meaning and impact of this release and agree to be bound by its terms.


Signature*      Date*

EXCLUSION POLICY
It is the policy of City of Good to restrict or exclude employees/volunteers/trainees who are sick or have infected cuts or lesions. Employees/volunteers/trainees with these conditions shall inform the person-in charge. At that time, a decision will be made whether or not to exclude from service or restrict their activity based on the conditions. As employees/volunteers/trainees in the food service industry, you should be aware of the potential risks and hazards that your health plays in the public health of our community. Each case will be reviewed individually and handled as the facility deems appropriate. This may result in different jobs or positions in the facility during the illness or condition and possibly the exclusion from work entirely. An employee/volunteer who has any of the following symptoms: Diarrhea, Fever, Vomiting, Jaundice, Sore Throat with Fever, Coughing or Running Nose, etc., will be excluded from the facility until the individual is symptom free.

Any employee/volunteer who is exposed to or diagnosed as being contagious with any of the following: Salmonella Typhi, Shigella ssp., E. Coli 0157:H7, or Hepatitis A virus, Norovirus, etc., will be excluded from work until documentation is provided from a licensed physician indicating the person is free of the infectious agent of concern. The person-in charge of the facility involved is also to contact the local health department, informing them of the diagnosis, and is to receive their approval prior to the employee/volunteer returning to work. The following individuals have read and understand that they must report to the person-in charge any of the above-mentioned symptoms or illnesses.

By my signature below, I acknowledge that I have read the above, understand it, and agree to the terms.

Applicant Signature*   Date*