#2 - POC Volunteer Application Form & Confidentiality Agreement

Today’s Date:*

Date

Your Name:*

First NameLast Name

Your Email:*

example@example.com

Your Phone Number:*

Please enter a valid phone number.

Your Company Name:*

Number of Years as a POC Member:*

Your Chapter/Location:*

Volunteers are required to provide and/or agree to the following:

Agree to participate in the committee or board meetings as scheduled;
Agree to maintain ethical behavior according to the POC Code of Ethics;
Agree to read and abide by the applicable Volunteer Boundary Document and the Volunteering Steps to Resolution Policy and Procedure, if any;
Agree to read and meet the Roles and Responsibilities for the volunteer role, if applicable;
Conform to the Conflict of Interest and Code of Conduct Policies of POC.

Volunteer position or committee of interest:*

List any previous experience with volunteer work:*

Briefly describe your special interests, skills and strengths:*

I, First Name* Last Name* agree to abide by all of the points above.

YesNoOther

Signature (use trackpad/stylus/fingertip/mouse):*

Volunteer Application Form