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  • Volunteer Inquiry/Application

    Please note: Nearly all our volunteer opportunities require some weekday availability. Contact us before filling out an inquiry/application to discuss if you think this will be an issue. Thanks!
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  • Which programs interest you?

  • Background

  • Emergency Contact Information

    Please provide contact information for someone we can contact in case of an emergency

  • Demographics

    We ask these questions to track our efforts to engage with volunteers representative of the diversity within the communities we serve. You are welcome to select "Prefer not to answer" if you would rather not share this information.

  • We hope to learn:

    1. Whether diverse subsets of the population are represented among our volunteers.

    2.  If we're missing any opportunities to engage with potential volunteers, and how to connect with prospective BIPOC volunteers.

    3.  What we might do better.

    How:

    We have modeled the following demographic questions after the 2020 census, so that we can compare our volunteer makeup with publicly-available population data.

    Notes:

    Please answer both the question about Latinx origin and the question about race.  This survey considers Latinx background to be an ethnicity, rather than a race.



  • References

    Please list two non-family references, including one professional contact.

  • The Money Management program requires a third non-family reference

  • Agreements

  • Conflict of Interest Agreement

    I certify that if I become a volunteer of Somerville-Cambridge Elder Services, my involvement with clients will not constitute a potential conflict of interest.  
     
    I agree that I: 

    • will never use my knowledge of any client’s situation for my own benefit or financial gain, or that of my employer, associates, family, friends or acquaintances.  
    • will not make suggestions or recommendations to any client from which I, my employer, associates, family, friends or acquaintances may profit or benefit in any way.  
    • will not accept payment, loans, or gifts of money or property from any client, except non-cash personal gifts, the value of which shall not exceed $25 in any calendar year.  
    • will refrain from giving any client financial, health care, or property advice.
    • will avoid any activity which would place me in a position of actual conflict of interest or the appearance of conflict of interest. 
       

  • Client Confidentiality Agreement

    SCES staff and volunteers follow federal “HIPAA” and Massachusetts’ “WISP” privacy laws, which means our clients’ information is confidential.  Please safeguard their names, addresses, contact info, and health or finacial information.  Please also refrain from photographing our consumers or using their likeness (we ask written permission to take photos).

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  • CORI Form and Government-Issued Identification

    The CORI is a required criminal background check standard for all community-based volunteers. According to MA General Laws Chapter 6 Sec 167-178B, we are required to request a CORI of potential volunteers who will meet with clients. 

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    THE COMMONWEALTH OF MASSACHUSETTS

    EXECUTIVE OFFICE OF PUBLIC SAFETY AND SECURITY

    Department of Criminal Justice Information Services

    200 Arlington Street, Suite 2200, Chelsea, MA 02150

    TEL: (617) 660-4640/ TTY: (617) 660-4046/ FAX: (617) 660-5973

    MASS.GOV/CJIS

  • Criminal Offender Record Information (CORI)

    Acknowledgement Form

  • To be used by organizations conducting CORI checks for employment, volunteer, subcontractor, licensing, and housing purposes.

    Somerville-Cambridge Elder Services, Inc is registered under the provisions of M.G.L c.6, § 172 to receive CORI for the purpose of screening current and otherwise qualified prospective employees, subcontractors, volunteers, license applicants, current licensees, and applicants for the rental or lease of housing.

    As a prospective or current employee, subcontractor, volunteer, license applicant, current licensee, or applicant for the rental or lease of housing, I understand that a CORI check will be submitted for my personal information to the DCJIS.  I hereby acknowledge and provide permission to Somerville-Cambridge Elder Services, Inc. to submit a CORI check for my information to the DCJIS.  This authorization is valid for one year from the date of my signature.  I may withdraw this authorization at any time by providing Somerville-Cambridge Elder Services, Inc. with written notice of my intent to withdraw consent to a CORI check.

    FOR EMPLOYMENT, VOLUNTEER, AND LICENSING PURPOSES ONLY:

    Somerville-Cambridge Elder Services, Inc. may conduct subsequent CORI checks within one year of the date this Form was signed by me, provided, however, that Somerville-Cambridge Elder Services, Inc., must first provide me with written notice of this check.

    By signing below, I provide my consent to a CORI check and affirm that the information provided on Page 2 of this Acknowledgement Form is true and accurate.

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    THE COMMONWEALTH OF MASSACHUSETTS

    EXECUTIVE OFFICE OF PUBLIC SAFETY AND SECURITY

    Department of Criminal Justice Information Services

    200 Arlington Street, Suite 2200, Chelsea, MA 02150

    TEL: (617) 660-4640/ TTY: (617) 660-4046/ FAX: (617) 660-5973

    MASS.GOV/CJIS

  • SUBJECT INFORMATION
    Please complete this section using the information of the person whose CORI you are requesting. The fields marked with an asterisk (*) are required fields.

     

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  • Government-issued photo identification is required to run a CORI check.

    Please supply one of the following: driver's license, state ID, passport, foreign passport with Visa, or U.S. military ID.
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  • Please sign to certify:

    I understand that the references I have listed will be contacted and that the sponsoring agency will do a records check on qualified applicants. I consent to the release of all relevant information concerning my ability and fitness to volunteer. I certify that the information given herein is accurate to the best of my knowledge. I understand this information will be held in confidence and not released to another agency.
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