Volunteer Application

Family House Volunteer

Application Form
Please fill out the application below if you would like to become a House Volunteer. House Volunteers are asked to commit to at least 2 shifts per month, but can volunteer for as many as you want! There are 2 types of volunteer shifts (and some people do both):
- Regular Shifts: scheduled weekly or bi-weekly (e.g. every Tuesday 11:30am-3pm)
- Floater Shifts: Pick up shifts as they fit into your schedule
Once your form is submitted, our Volunteer Coordinator will reach out via email and/or phone to discuss available opportunities.

*Please Note: Applicants must be at least 18 years of age to be considered for a House Volunteer role.
Personal Information
Name*

First NameLast Name
Birth Date*

MonthDayYear
Email*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred method of contact:*
How did you hear about Family House?
Community Affiliations (if any):
Skills, Interests, and Hobbies:*
Which of the following volunteering activities interest you?*

Background
Education Completed*

High School or EquivalentCollege GraduateSome College or Technical SchoolOther
Are you currently employed?*

Yes, full-timeYes, part-timeNoStudentRetired
Current or Most Recent Employer
Occupation or Course of Study
Do you have any volunteering experience? If yes, please describe.*

Criminal Background Information

In answering the following question, do not disclose convictions that have been expunged, sealed, or statutorily eradicated; misdemeanor convictions for which probation has ben successfully completed or discharged and the case has been judicially dismissed; or any referrals to a pre-trial or post-trial diversion program.
Have you ever been convicted of or pled guilty to a felony?*

YesNo
Have you ever been convicted of or pled guilty to a misdemeanor that might be related in some way to the position for which you are applying (including convictions relating to honesty, integrity, or illegal use of drugs)?*

YesNo
If you answered "Yes" to either of the above questions regarding convictions, please describe the conviction(s) in detail, including dates:

CONFIDENTIALITY AGREEMENT
I understand my responsibility as a Volunteer at Family House is to ensure that all rules of strict confidentiality are observed. All donor/guest/employee lists are property of Family House. All donor/guest/employee lists should be treated as physical property and considered highly confidential. Therefore, I agree not to disclose any confidential information to parties while volunteering at Family House or after I leave.

I also understand that any breach of confidence of these records will be cause for immediate dismissal. I understand that I may have access to confidential medical information both written and oral.

I further agree that I will neither disclose to any unauthorized individual nor use for my personal benefit during or after my volunteering, any information relating to Family House’s confidential information unless specifically authorized in writing by the Family House Executive Director.

I will promptly deliver to Family House upon voluntary or involuntary separation as a volunteer with Family House or at any time that it may request: manuals, lists, forms or other printed and/or electronic information of a confidential nature belonging to Family House.

If I become aware of any confidential information being disclosed (even inadvertently) I will inform the Volunteer Coordinator immediately.
Signature of Agreement

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Agreement
The statements I have made on this form are true and correct to the best of my knowledge. I understand any omission of facts by me is cause for immediate dismissal.I understand that I am volunteering my time without contemplation of compensation or employment and given with humanitarian, religious, or charitable reasons.I release Family House and its operating divisions and agents from any and all claims, causes of action, and liabilities arising out of any and all investigation, background checks, and verification of the information I have provided and its determination of any qualifications and abilities.I understand that, if accepted as a volunteer, I will be required to abide by all of the policies, rules, and regulations of Family House.
Date*

MonthDayYear
Date
Signature*

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