CONSENT FOR CRIMINAL BACKGROUND and DRIVING RECORD CHECK
I hereby give unrestricted permission to Community Homes for Adults Inc. (CHAI) to obtain information relating to my criminal background history and Department of Motor Vehicles (DMV) record. The criminal background history and DMV record, as received from the reporting agencies, may include arrest and conviction data as well as plea bargains and deferred adjudications. I understand that this information will be used, in part, to determine my eligibility for a volunteer position with CHAI. I also understand that as long as I remain a volunteer of CHAI, the criminal background and DVM records check may be repeated at any time. If denied eligibility to volunteer based on check findings, I understand a procedure is available for clarification.
I, the undersigned, do for myself, my heirs, executors and administrators, hereby remise, release and forever discharge and agree to indemnify CHAI, the company performing the criminal background and DMV records check, and each of their officers, directors, employees and agents harmless from and against any and all causes of actions, suits, liabilities, costs, debts and sums of money, claims and demands whatsoever, including negligence and gross negligence and any and all related attorney’s fees, court costs, and other expenses resulting from the investigation into my criminal background and DMV records in connection with my application to become a volunteer of CHAI.
I understand that I have the obligation to report to CHAI any changes in my criminal background and/or DMV records history after the date that I sign this form, the Community Homes for Adults Inc. Volunteer Application, including this Consent for Criminal Background and DMV Records Check.
VOLUNTEER CODE OF ETHICS
Fulfill assignment responsibility: Carry out all aspects of your assignment, attend all required meetings, and notify the volunteer coordinator if you cannot complete an assignment.
Set a good example for the residents: Refrain from smoking, consuming alcohol or using profanity. As a volunteer, be discreet in your personal relationships with residents and avoid any behavior which may be misunderstood or misinterpreted. Be helpful to and supportive of everyone associated with CHAI.
Be vigilant and aware of the safety of the residents: Never leave a resident un-chaperoned and report anything you observe, either in the physical environment or in the individual’s behavior, which you feel may cause potential harm.
Take advantage of the opportunities CHAI offers you: Be open to new ideas and new ways of doing things. Become an active participant by extending your involvement to other roles of leadership and delight in the change your involvement makes in the life of someone you know and in the many lives of those you’ll never meet.
PLEASE READ BEFORE SIGNING
I understand that:
Ø The information that I have provided will be verified, and I give permission to CHAI to make inquiries, which will include a criminal background and DMV records check to determine my suitability to act as a CHAI volunteer.
Ø In the course of volunteering for CHAI, I may become privy to confidential information and I agree to keep such information in the strictest confidence.
Ø The relationship between CHAI and volunteers is an “at will” arrangement. It can be terminated at any time without cause by either me or CHAI.
Ø I grant CHAI permission to use my likeness, voice, and other words in television, radio, film or in any form to promote activities of CHAI.
I affirm that I have read, reviewed and received a copy of the Consent for Criminal Background and DMV Records Check, the Volunteer Code of Ethics and the CHAI Client Rights and Abuse Prevention Policy, as well as that the information I have provided on this form is true and complete.