COURT APPOINTED COMMUNITY SERVICE APPLICATION

COURT APPOINTED COMMUNITY SERVICE APPLICATION
Fill out completely or the application will be VOID. This application is for COURT appointed community service.
PERSONAL INFORMATION
Name*
DOB*
Phone*
Email*
example@example.com
Street Address, City, State, Zip*
EMPLOYMENT INFORMATION
Company/Employer Name*
Position/Title*
Work Phone Number*
Dates of Employment (starting-ending)*
Employment Address*

Employer Street Address

Street Address Line 2

Employer City, State, ZipState / Province

Postal / Zip Code
What was your offense*
COUNTY OF OFFENSE*
COUNTY OF SERVICE HOURS*
REFERENCES- please provide three references. You must include their name, relationship to you, their phone number, and how long you've known them.
Reference 1: *
Name, relation to you, phone number & time known
Reference 2: *
Name, relation to you, phone number & time known
Reference 3: *
Name, relation to you, phone number & time known
PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING THIS APPLICATION

I understand that this is an application for, and not a commitment to or promise of, a Community Service Opportunity. I certify that I have and will provide throughout the selection process, including on this application for a Community Service position and in interviews with Waxahachie CARE Services that this information is true and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for Community Service. I understand that information contained on my application will be verified by Waxahachie CARE Services. I understand that misrepresentations or omission may be cause for my immediate denial as an applicant for a Community Service position with Waxahachie CARE Services or my termination as such.
Community Service Volunteer Signature*

Clear
Date*

MonthDayYear
Date
CONFIDENTIALITY & CONSENT TO PHOTOGRAPHS AND VIDEO'S
I, ____________ , a Volunteer at Waxahachie CARE Services, understand that I will have access to confidential client information in a variety of forms each time I am at the facility.

I understand and agree that the policy of this organization is that all such information is to be kept strictly confidential and that I am permitted to access and use such information only as necessary to perform my volunteer duties at Waxahachie CARE Services.

I understand that to disclose or reproduce any confidential information in any form is a violation of this policy and Waxahachie CARE Services has the right to take legal action if necessary. Such action may be subject to fines or penalties under federal and state law.

By signing this application, I am giving my permission to be photographed and videod for the purpose of promoting, bringing awareness, and to bring a positive view on Waxahachie CARE Services. This includes, but not limited to, all social media platforms, website, printed material, and any other means to benefit Waxahachie CARE Services.
Signature

Clear
Date*

MonthDayYear
Date
Waxahachie CARE Community Service Rules

Waxahachie CARE is a nonprofit organization that relies on volunteers for its daily operations. The acceptance of this application is based on the information provided and the needs that we have at the time. Based on your application and the interview process we will determine if the applicant will be a good fit at Waxahachie CARE. If you feel at any time that the relationship is no longer a good fit, you may terminate your relationship with Waxahachie CARE.

RULES:
1. Wear closed toed shoes at all times.
2. Cell phones do not need to be used in working areas but, *If a call is needed you may step outside away from the neighbors and away from the warehouse and pantry area for safety reasons.*
3. Music is not allowed while volunteering regardless of device. *no ear buds, headphones, etc*
4. Food and Drink are only allowed in the Kitchen area.
5. Sign in AND out each time you volunteer. Breaks and lunch may be taken when you feel you need them, however, be mindful of others and let the supervisor know when you are leaving. *Community Service Volunteers MUST sign in and out or your hours will not be counted.*
6. Use appropriate hand washing procedures and wear gloves as needed.
7. Clean your area (kitchen, pantry, warehouse, and office) before leaving each day. Including but not limited to:
- Throw away trash.
- Wipe down counters.
- Empty trash cans when full and replace with new bag.
- Put boxes, crates, carts, totes, and all other supplies in appropriate places.
THE FOLLOWING ARE GROUNDS FOR IMMEDIATE TERMINATION OF DUTIES
- Demeaning language such as name calling to the neighbors, volunteers, staff, or other individuals.
- Inappropriate behavior deemed by Waxahachie CARE staff.
- Inappropriate/profane language.
- Threatens, uses or brings any type of weapon on the property.
- Stealing or taking things without permission.
- Refusal to follow rules of Waxahachie CARE.
- Disrupting, causing chaos, or incapable of interacting with other in a positive manner.
- Cannot physically perform the necessary tasks assigned to them.
I understand the above rules and will follow them or be subject to IMMEDIATE termination. The statements above are not a full and extensive list and can be added to by Waxahachie CARE staff.
Signature*

Clear
Date*

MonthDayYear
Date
I have read and agreed to the terms and rules above and submit my application to Waxahachie CARE Services for approval.*

I agree
Signature

Clear
Should be Empty:

COURT APPOINTED COMMUNITY SERVICE APPLICATION

CONFIDENTIALITY & CONSENT TO PHOTOGRAPHS AND VIDEO'S