Volunteer Application - Nygil Cullins Recovery & Community Center

Dear Prospective Volunteer,

The Department of Volunteer Services of the Nygil M. Cullins Recovery Housing and Community Center was established in 2022 in Macon, Georgia. Nygil M. Cullins’ life was tragically cut short. Having his own mental health battles, on the night of Nygil’s death, he underwent a mental break. His mother, Dr. Mya Speller Cullins continues this legacy through the Nygil M. Cullins Semi-Independent Recovery Housing and Community Center. He also left us the legacy of ensuring we care for others in our community, not forgetting to extend a helping hand. Every person who successfully completes the program at this Community Center, is proof that true superheroes never will never die. They always find a way to rescue those who are in need. The Nygil M. Cullins Semi-Independent Recovery Housing & Community Center has and continues to rescue the often misunderstood, forgotten, and rejected in our communities. Our volunteers work with various capacities based onour need and the specialty or interest per volunteer that comes aboard. We make every effort to place individuals in the position of their interest. However, volunteer position availability varies. Enclosed you will find information listing requirements needed to take the next step with becoming a volunteer for the Nygil M. Cullins Recovery Housing and Community Center.

When completing the application please PRINT or TYPE your entries. Do not mail your application. Please call Beyond Your Ordinary Inc. to schedule an appointment for a screening interview if you are looking for a volunteer position. Your completed application should accompany you to the interview. Once you have successfully met the requirements, including a reference and criminal background check, an interview with a potential site supervisor should be scheduled. A request for a resume may be made for certain placements. Once you have secured a volunteer position, you must complete the mandatory Volunteer Services Orientation for Nygil M. Cullins Recovery Housing and Community Center.

You will learn about the history of Nygil M. Cullins Recovery Housing and Community Center volunteer program, policies and procedures, benefits, and recognition. We look forward to having you as a valuable addition to Nygil M. Cullins Recovery Housing and Community Center. Please note that the process of becoming a volunteer may take some time, but it will all be worth it. For questions regarding the volunteer application process, contact the Department of Volunteer Services at 336-268-6469 or myacullins@gmail.com. We look forward to welcoming you as one of our newest volunteers. Thank you for your interest.

Sincerely,
Mya Speller Cullins, Founder/ Volunteer Services

Sarah Jettie Community Development Volunteer Services Application Checklist

The following are the steps to become a volunteer at Sarah Jettie Community Development. Check each step once it has been completed. When all indicator boxes are checked you will then be a Sarah Jettie Community
Development Volunteer!

1. □ Complete Application Packet. Do not mail application. (If you have been preselected, see step #4.)
2. □ Schedule a screening Interview with a representative of the Department of Volunteer Services. If you have been preselected by a department, turn in all of your paperwork and contact Volunteer Services to receive your orientation details. (A reference and criminal background check are required as part of the selection process.) Note: Call the Department of Volunteer Services at 3362686469 or by email at myacullins@gmail.com to schedule the screening interview if you are looking to secure a volunteer position. Bring the completed application packet with you to the screening interview or to the Department of Volunteer Services if you have been preselected.
3. □ Contact Volunteer Services two days after you have completed your screening interview to confirm that your background and reference check have cleared.
4. □ Meet with the supervisor from your potential volunteer assignment site. (You will need to schedule this interview.) □Your supervisor should fill out a Placement Interview Form which must be returned to the Volunteer Office. 4. □ Complete the Volunteer Services Orientation . Your application, background check information and placement form should be submitted prior to taking the orientation training and receiving instructions via e-mail.)
5. □ Get proof of TB clearance from Occupational Health and turn documentation into the Department of Volunteer Services. Once you have the TB screening evaluated, please bring a form stating that you qualify to be a volunteer to the Department of Volunteer Services. 6. □ Obtain a volunteer badge from the Department of Volunteer Services. Note: You must turn in your application, background check form, placement form, orientation certificate and TB clearance before getting a volunteer badge. Our office hours are 10:00 a.m. to 4:00 p.m., Monday through Friday. You must present a valid Sarah Jettie Community Development Badge before receiving the volunteer badge.
7. □ Procedure for signing in and out: A. There is a time clock machine and or a sign in book available Monday through Friday from 10:00 a.m. to 4:00 p.m. B. All time must be logged in in order to receive credit (must have verification of all time)

VOLUNTEER REQUIREMENTS
Minimum Age: 15 years and enrolled in high school courses. Number of Hours Required: Volunteers must commit to a minimum of 75 hours of service and a minimum of 4 hours of service per week is required. However, the number of hours may be subject to change depending upon the needs of the department and volunteer and with approval of the volunteer supervisor. Interview(s): A screening interview must be scheduled with the Department of Volunteer Services if you have not been pre-placed in a department. Applicants are reviewed and considered based on assessed skills, interests, level of demonstrated commitment and the availability of volunteer positions. The reference check and a criminal background check are then conducted. Upon successful completion of these checks, the applicant must schedule and attend an interview with a potential supervisor. During this interview a Placement Interview form must be completed by the interviewer and applicant. Health Related Documentation: Volunteers considering serving patient care areas who were born after January 1, 1957 must provide documentation of varicella (chickenpox) and measles/mumps/rubella (MMR) vaccination. Employees, faculty, physicians, staff, students and volunteers across Sarah Jettie Community Development, are required to receive the flu vaccination during flu season. The seasonal flu vaccine is provided free of charge to all volunteers.

All prospective volunteers are screened for tuberculosis and must be determined to be free of active infection by the Department of Occupational Health before beginning service within the Hospital. Any volunteer with a positive reaction to the PPD test is advised to follow up with a chest x-ray and further medical treatment if so determined. Volunteers who serve clinical areas must receive a TB screening on an annual basis to maintain an active status. Orientation and Training: Once the application, background check, interviews and placement form have been completed the prospective volunteer must enroll in the required orientation. Training topics include a general overview of the volunteer program, benefits and expectations. The online training can be taken on any computer with an internet connection. Volunteers must repeat the Volunteer Services Orientation course annually to maintain an active status. Volunteers should be properly trained by their departmental supervisor or designated staff to successfully complete assigned tasks. This training is divided into two areas: basic workplace instruction (e.g. location of bathroom, where to put coat, etc.) and job instruction. Attendance: Volunteers are expected to meet their commitments to their scheduled service hours. Supervisors must be notified of any absences in advance or as soon as possible. The Department of Volunteer Services should be notified of any extensive absences. After 3 consecutive unexcused absences without notification, the supervisor and/or the Department of Volunteer Services reserve the right to terminate a volunteer. All volunteers must sign –in and –out when reporting for service. Failure to do so and illegible handwriting will result in service hours not being recorded. Time can be recorded on a timesheet, online or via email. Evaluation: All volunteers should demonstrate a good understanding of assigned tasks. A competency assessment by the supervisor should be given after 90 days of service and then on an annual basis of the start date.

Date

Name *

First Name Middle Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home Telephone or Cell Telephone *

Please enter a valid phone number.

Email *

example@example.com

Education/Special Training Highest Grade Level Completed *

Employer’s Name/School’s Name Occupation/Academic Major *

Parent’s/Guardian’s Name (if under 18 yrs.)

First Name Last Name

Supervisor’s Name & Signature (if Hopkins employee)

First Name Last Name

Supervisor’s Signature (if Hopkins employee)

Powered by Jotform Sign

Clear

Are you at least 18 years of age? *

Yes No

Do you have a M.D./PhD? *

Yes No

Do you have a B.S. in Medicine? *

Yes No

How did you hear about the Volunteer Services Department? *

Are you required to volunteer? If yes, please explain. *

Have you ever been convicted (found guilty) of a crime (including probation(s) before judgment), or are there any pending criminal charges awaiting a hearing in a court of law? Do not list any criminal charges for which records have been expunged. *

Yes No

If you answered YES, please describe all convictions, when they occurred, the facts and circumstances involved, and information pertaining to rehabilitation.

Volunteer Experience: (List most recent service positions) *

List most recent agency. *

Placement Preferences:

1. Administrative: Administrative and clerical duties.

2. Child Life: Help children with recreational/educational activities.

3. Non-Clinical: Clerical, running errands, answering phones.

4. Library: Visit in-patient areas with book-cart, respond to request for books.

5. Nursing: Assist nurses, interact with patients, and assist with meals and paperwork.

6. Pharmacy: Shelve
medications, prepare and label materials, and stock rotation.

7. Other:

Please indicate your top 3 Placement Preferences from the above list
1st blanks
2nd blank*
3rd blank*

Proposed Start Date: *

Date

Proposed End Date: *

Date

References and Emergency Contact *

First Name Last Name

Duration of Volunteer Services: *

One Time 1-3 Months More than 3 months On call Other

References: List two people other than relatives who would be willing to serve as personal references *

First Name Last Name

Reference 1 Phone Number *

Please enter a valid phone number.

Reference 1 Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Reference 1 Email Address *

example@example.com

Reference 2 Name *

First Name Last Name

Reference 2 Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Reference 2 Phone Number *

Please enter a valid phone number.

Reference 2 Email Address *

example@example.com

Emergency Contact Name *

First Name Last Name

Emergency Contact Relationship *

Emergency Contact Phone Number *

Please enter a valid phone number.

Statement of Understanding: I certify that all information is true and has been given voluntarily. I understand that this information may be disclosed to any party with legal and proper interest. I release the Nygil M. Cullins Recovery Housing and Community Center from any liability whatsoever for supplying such information. I understand that I must be at least 15 years of age to volunteer at Nygil M. Cullins Recovery Housing and Community Center and if I am under the age of 18 years of age and/or attending high school I will need parental consent. Upon being offered a volunteer position, I understand that I may be required to provide additional information pertinent to the position for which I applied.

Applicant Signature *

Powered by Jotform Sign

Clear

Date

Parental Signature *

Powered by Jotform Sign

Clear

Date

What attracted you to this volunteer program? Is there an aspect within the program that motivates you to be a part of this program? *

What would you like to get out of your volunteer experience/internship? What would make you feel like you have been successful? *

Have you ever volunteered? If yes, for what agency and what position? *

Describe the agency and your volunteer responsibilities. *

What have you enjoyed most about your previous volunteer position(s)? *

Describe your ideal supervisor. What sort of supervisory style do you prefer to work? *

What skills and qualities do you feel you have to contribute to Nygil M. Cullins Recovery Housing and Community Center? *

Are you willing to commit to the requirements of the volunteer program? *

Nygil M. Cullins Recovery Housing and Community Center Volunteer Services Volunteer Application

Nygil M. Cullins Recovery Housing and Community Center Department of Volunteer Services

Nygil M. Cullins Recovery Housing and Community Center Department of Volunteer Services