Volunteer Intake Form -- 18 and older

Volunteer Intake Form

Thanks for applying for volunteer work with Love Chapel. You make a difference! You must be 18 years or older to apply.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Church Affiliation
Cell Phone*
Please enter a valid phone number.
Home Phone*
Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.

	8:30am-12:30pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

I give consent for my photo and/or recording of me to be used in social media or Love Chapel communications*

YesNo
I understand that while Love Chapel strives to maintain a safe environment, there are certain risks involved in volunteer roles. I will hold Love Chapel harmless if an accident/incident occurs.*

Yes. By checking this box you state that you agree and want to continue.No. By checking this box you state that you disagree and DO NOT want to continue.

Confidentiality and Security Agreement
Confidential Information:

I acknowledge that during the course of performing my assigned duties at Love Chapel, I may have access to, use, or disclose confidential information. I hereby agree to handle such information in a confidential manner at all times during and after my assignment at Love Chapel and commit to the following obligations:

a) I will use and disclose confidential information only in connection with and for the purpose of performing my assigned duties.

b) I will request, obtain or communicate confidential information only as necessary to perform my assigned duties and shall refrain from requesting, obtaining or communication more confidential information than is necessary to accomplish my assigned duties.

c) I will take reasonable care to properly secure confidential information and will take steps to ensure that others cannot view or access such information.

Security:

I acknowledge that based upon my volunteer position a criminal background check may be required.

I acknowledge that during the course of performing my assigned duties at Love Chapel I will not remove any items from either building for my personal use.

a) Authorization to remove items from the buildings for personal use may be allowed at the authorization of a staff person. When the item is given to the person a signed paper acknowledging it was given and received is kept in their file.

b) During working hours, drinks and snacks are allowed. These can come from available supplies in the kitchen areas. These snacks are not to be taken from incoming donations or donations in warehouse or on shelves.

Conduct:

I agree that while assigned to work at Love Chapel I will uphold the highest possible degree of conduct.

a) This includes appropriate attire, appropriate language, smoking only off the premises, and proper interaction with staff, volunteers and clients.

b) In addition if there are any confidential issues, discuss those issues only with the Executive Director.
Yes. By checking this box you state that you agree and want to continue.No. By checking this box you state that you disagree and DO NOT want to continue.

Civil Rights Training
It is important that all Love Chapel clients/guests be treated equally, fairly, with dignity, and without discrimination of any kind.
Discrimination of any kind is prohibited, including race, color, national origin, age, sex, religious affiliation, and disability. Discrimination can be intentional or unintentional. Be mindful not to make statements that could viewed as discriminatory even if that is not your intent.
Love Chapel makes every effort to accommodate clients/guests with disabilities.
Clients with no or limited English proficiency will be served to the best of staff/volunteer abilities. Interpreters, phone apps, etc. may be used when available to aid communication.
Love Chapel conducts outreach into the community to make sure eligible persons and households are aware of services offered.
Confidentiality must be maintained. It is not appropriate to talk about who is receiving benefits/services and to make remarks about them, both while at Love Chapel/Brighter Days and out in the community. Information should not be shared with others regardless of the intentions of that expression. Refer all requests for information to managers.
Sexual harassment is prohibited. Do not engage in or tolerate unwanted or unwelcome sexual behavior including jokes, touching, requests for sexual favors, etc. Report violations to management.
If a client/guest claims they have been discriminated against, contact management immediately.
Any conflicts with clients/guests should be reported immediately to management. Call 911 immediately if you feel threatened and management is not available.
In general, follow the Golden Rule and treat people like you would want to be treated.
Yes. By checking this box you state that you agree and want to continue.No. By checking this box you state that you disagree and DO NOT want to continue.

Volunteer Expectations
We are so excited to have you join our volunteer team! As a volunteer we have certain expectations that are in place for you, our clients, and us as an organization. If you could please read through and acknowledge that you have read them.

I will be confidential with all client information including not taking photos of client(s) or sharing any of their personal information.
I will strive to treat each client with respect and avoid making judgments as I do not know the client(s) life circumstances.
I recognize that Love Chapel and Brighter Days serves clients with diverse backgrounds and beliefs. I agree to not discriminate and to treat each guest with dignity.
Love Chapel is a Christian organization. As a volunteer, I can share my faith, but I will never impose my beliefs on a client as that produces barriers for the client.
For my protection, I will not drive clients.
For my protection, I will not go into isolated areas with clients.
If I suspect that a client is a victim of abuse or neglect, I will privately discuss my concerns with a staff member who is a court mandated reporter and can also arrange for a St. Vincent referral.
If I work in the pantry, I will not play favorites in the food distribution.
I recognize that as a volunteer, I can have a snack at the pantry, but I am not allowed to take donated food offsite.
I will treat other volunteers and staff with respect.
Yes. By checking this box you state that you agree and want to continue.No. By checking this box you state that you disagree and DO NOT want to continue.

What is the purpose of your initiative to volunteer?*

School ProjectWork (Company's Program)Court Ordered Community ServiceIndividual (not related to any other program mentioned above)
What is the reason for your community service?*
How many hours do you need to work?*

DISCLOSURE and AUTHORIZATION – BACKGROUND INVESTIGATION
DISCLOSURE and AUTHORIZATION – BACKGROUND INVESTIGATION

In connection with my application for employment or to serve as a volunteer with Ecumenical Assembly of Bartholomew County Churches, Inc./Love Chapel (“Client”), I understand that an “investigative consumer report,” as defined by the Fair Credit Reporting Act (15 U.S.C. 1681), will be requested by Client for employment or volunteer purposes, whichever is applicable, from Protect My Ministry, Inc., (“Protect My Ministry”), a consumer reporting agency defined by the Fair Credit Reporting Act. These reports may include information as to my character, general reputation, personal characteristics, or mode of living, whichever are applicable*. The report may also contain information about me relating to my criminal history, driving and/or motor vehicle records, social security number verification, verification of education or employment history or other background checks. Such reports may be obtained at any time after receipt of this Disclosure and Authorization and if I am hired to serve as a volunteer, whichever is applicable, throughout the course of my employment or volunteer service, as permitted by law and unless revoked by me in writing. Client also reserves the right to share my report with any third party with whom I will be placed to work or volunteer with as a representative of Client. I understand that I have the right, upon written request made within a reasonable amount of time after the receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report to Protect My Ministry, Inc., 14499 N. Dale Mabry Hwy., Suite 201 South, Tampa, FL 33618 or 1-800-319-5581. For information about Protect My Ministry’s privacy practices, see www.protectmyministry.com.
* Love Chapel utilizes Protect My Ministry ONLY for the purposes of requesting a criminal background check. Love Chapel will never use your information to access personal data beyond the content of a criminal background check, and this information will not be shared externally for any reason.

Acknowledgment and Authorization

By signing below, I authorize Client or its authorized agents to obtain or prepare consumer reports or investigative consumer reports about me ONLY for the purposes of a criminal background check. I acknowledge receipt of a copy of the federal notice entitled A Summary of Your Rights under the Fair Credit Reporting Act and certify that I have read this Disclosure and Authorization as well as the summary document explaining my rights under the Fair Credit Reporting Act.
Yes. By checking this box you state that you agree and want to continue.No. By checking this box you state that you disagree and DO NOT want to continue.
SSN*
D/L or State ID*
State Issued*
Please list other names used:*
Should be Empty:

Volunteer Intake Form

Confidentiality and Security Agreement

Civil Rights Training

Volunteer Expectations

DISCLOSURE and AUTHORIZATION – BACKGROUND INVESTIGATION