Confidential Volunteer Application

Confidential Volunteer Application

All information in this application will be kept strictly confidential and shall be used only in the administration of our services.
PERSONAL INFORMATION
Name

First NameLast Name
Preferred Name
Date Submitted

MonthDayYear
Date
Submitted Background Check to Monica
Is this person clear to Volunteer at SAAF
HIV 101 Class completed
Notes:
HIPAA Certificate

Cancelof
Data Security and Confidentiality Certificate

Cancelof
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number
If you not have one, please type N/A
Driver License Number
If you not have one, please type N/A
Please provide a photo of the front of your Driver License

Cancelof
Phone Number
If you not have one, please type 210 000 0000Format: (000) 000-0000.
Best time to contact you
Email
If you not have one please type example@example.com
May we add your email to the SAAF Newsletter to keep you connected with updates and volunteer opportunities?
Ethnicity (Optional, for grant purposes only)
Can we say we are calling from SAAF?
Date of Birth

MonthDayYear
Date
Age
Sex assigned at birth
Gender Indentity

Other
Current Employer and Years Employed
Occupation
Former Employer
Last Date of Employment

MonthDayYear
Date
Position
Do you claim any disabilities or have any physical limitations that might interfere with your work? If yes please explain:
Have you ever been convicted of a felony? If yes, please explain
List of Prior Volunteer Activity (community, church, etc.):
Hobbies:
EDUCATION
School Attended 1:
Degree (if applicable):
Major (if applicable):
School Attended 2:
Degree (if applicable):
Major (if applicable):
Special Skills, Foreign Languages, Interests, Experience:
Briefly explain why you want to be a volunteer at SAAF
In case of emergency, please contact:
Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Other information
How did you hear about SAAF
Are you volunteering as part of a school volunteer program?
If so, which school program?
Are you volunteering to fulfill volunteer requirements for school or work?
If yes, how many hours are required?
Are you part of an organization/company volunteer group?
Provide the contact information for the person who manages or leads the group, including their full name, phone number, and email.
If you don’t have this info, please ask your manager/lead to email the group details to hello@sanantonioaids.org
Are you volunteering to fulfill court-mandated community service?
If yes, how many hours are required?
These hours need to be completed by:

MonthDayYear
Eligibility can take a few days. If your deadline is near, call 726-233-8982 for options.
Do you have your own method of transportation?
If yes, what type of vehicle do you drive?

Other
Would you be willing to use your vehicle for SAAF volunteer activities (transporting clients, hauling equipment, etc.?
Do you have the basic auto liability coverage required by the state of Texas?
Can you estimate how long you intend to volunteer at SAAF? (Certain volunteer activities at SAAF require longer-term commitments)
What type of volunteer position are you applying for? (See Volunteer Job Describtions)
What type of volunteer opportunities are you applying for?

AVAILABILITY (Please indicate times you are available)

Rows	Morning(8am-Noon)	Afternoon(Noon-6pm)	Evening(5pm-6pm)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Please indicate other times you are available (Include if you only plan to come certain times per month, etc:
As part of our licensing agreement with the Texas Department of Health, all volunteers working on the premises or with clients are required to complete orientation and training. This training includes facility policies concerning areas such as confidentiality, infection control and sanitation, emergency procedures and evacuation plans, and specific training for assigned tasks. Persons applying for Special Events Only positions do not need to attend volunteer training, unless specified by the event. Are you willing to go through volunteer training?
VOLUNTEER POLICY STATEMENT
Confidentiality of all information and records of clients is required. Breach of this policy is grounds for immediate termination of volunteers. All information obtained in any matter about a client or potential client will not be disclosed to anyone without the client's written consent, except as authorized by law. Volunteers are prohibited from using or soliciting SAAF materials for personal use. In addition, volunteers will not accept material compensation or gratuity for their efforts. Acceptance of and agreement with these policies is a condition of volunteer service. Volunteers must sign this statement prior to SAAF's acceptance of their service. We reserve the right to refuse any person for volunteer service.
I HAVE READ THE AGREEMENT AND UNDERSTAND ITS CONTENTS.
Date

MonthDayYear
Date
I'm over 18 years old.
Legal Guardian Signature
Date

MonthDayYear
Date
This application will be review by the designed staff and you will be contact for a follow-up.
Should be Empty:

Confidential Volunteer Application

PERSONAL INFORMATION

EDUCATION

In case of emergency, please contact:

Other information

VOLUNTEER POLICY STATEMENT