WhirliDogs Training Center & CaféVolunteer Application and Agreement

WhirliDogs Training Center & CaféVolunteer Application and Agreement
"To enhance the Power of Possibility by creating a safe and inclusive environment, where all customers are welcomed and all staff are valued for their unique strengths and potential for growth."
Thank you for your interest in volunteering for WhirliDogs. Please complete this application for consideration. We will contact you soon to schedule an interview. The information on this application will be kept confidential. All WhirliDogs' volunteers will be required to have a criminal background check and to attend an orientation.
Please Print Legibly:
Name

First NameMiddle InitialLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
Email
example@example.com
Current employment
Employer
List any skills/talents/interests you could bring to WhirliDogs:
List any certifications such as CPR or First Aid you hold.
Dates and times you are available to volunteer
Do you have any experience working with individuals with disabilities?
If YES, in what capacity?
List any previous volunteer experience
I would like to obtain the ServSafe Food Handler Certificate
REFERENCES
List two people, not related to you, who have knowledge of your qualifications.
If you are a youth, please list references over the age of 25.
Reference 1 Name

First NameLast Name
Reference 1 Relationship
Reference 1 Phone Number
Format: (000) 000-0000.
Reference 2 Name

First NameLast Name
Reference 2 Relationship
Reference 2 Phone Number
Format: (000) 000-0000.

WhirliDogs Training Center, Inc. Volunteer Agreement
As a volunteer of WhirliDogs I agree to act as a representative of the organization.

In doing so, I understand that I am a reflection of the WhirliDogs Café's mission statement "To enhance the Power of Possibility by creating a safe and inclusive environment, where all customers are welcomed and all staff are valued for their unique strengths and potential for growth."
I agree to conduct myself in ways that support the WhirliDogs Café Objectives:
- To foster a sense of worth, connection and belonging for the teammates through training, employment and recognition systems.
- To demonstrate firsthand to the public the loyal and hardworking nature of people with disabilities and the benefits of employing these individuals within their businesses.
- To decrease the unemployment rates of people living with disabilities while filling the void of available trained and experienced hospitality workers to Wilson and surrounding areas.
- To provide hope to families by demonstrating there is a place of belonging in the local workforce for their family members with disabilities.
I understand that I will be volunteering at my own risk and that WhirliDogs Training Center, Inc., its board of directors, or its employees will not assume any liability for any accident, injury, or health problem which may arise from any volunteer work I perform. I agree that all the work I do is on a volunteer basis and that I am not eligible to receive any compensation.

I understand that each employee and/or volunteer must consent to a criminal background check and hereby authorize WhirliDogs to work with public law enforcement agencies or private organizations to have this criminal background check conducted.
Signature of Full legal name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
WhirliDogs does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations.

Notification and Authorization to Release Criminal Informationfor Employment / Volunteer Purposes
Notification
The position for which I am being considered requires me to consent to a criminal background check as a condition of employment. This check includes the following: Criminal history reference searches for felony and misdemeanor convictions at the county and federal levels of every jurisdiction where I currently reside or where I have resided during the past 7 years; and sex offender registry searches at the county and federal levels in every jurisdiction where I currently reside or where I have resided.
Authorization
I hereby authorize WhirliDogs to conduct the criminal background check described above. In connection with this, I also authorize the use of law enforcement agencies and/or private background check organizations to assist WhirliDogs Training Center, Inc. in collecting this information.
Please print (for identification purposes):
Full Legal Name

First NameMiddle InitialLast Name
Other Names You Have Used in Past Seven Years
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address (most recent)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Addresses in the 7 years prior to completing this authorization:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Alternate Phone Number
Format: (000) 000-0000.
Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender:
Have you ever been convicted of a criminal* offense or have any pending criminal* charges against you? *This refers only to felonies and misdemeanors; you do not need to include non-criminal traffic violations or municipal ordinance violations.
Please Provide Details:

Emergency Medical Authorization Form
Name:

First NameLast Name
DOB:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I hereby authorize / do not authorize Whirlidogs Training Center, Inc. to administer minor/emergency treatment of the person named above, should the need arise. If an accident occurs during a shift, every possible effort will be made to contact the emergency medical person listed below regarding such incident. I give permission to those administering emergency treatment to do so using measures deemed necessary. I absolve Whirlidogs Training Center, Inc. from liability in acting on behalf of the person listed above. In the event of a major emergency, the emergency contact will be called along with 911 and taken to the closest hospital.
Please list any medications the above-named employee/volunteer may be taking so emergency personnel can be informed.
Please list any medications the above-named employee/volunteer may be allergic to so emergency personnel can be informed.
Please list two emergency contacts with phone numbers.
1. Name

First NameLast Name
1. Phone Number
Format: (000) 000-0000.
1. Relationship
2. Name

First NameLast Name
2. Phone Number
Format: (000) 000-0000.
2. Relationship
Print Name:

First NameLast Name
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

WhirliDogs Training Center & CaféVolunteer Application and Agreement

Please Print Legibly:

REFERENCES

WhirliDogs Training Center, Inc. Volunteer Agreement

Notification and Authorization to Release Criminal Informationfor Employment / Volunteer Purposes

Emergency Medical Authorization Form

Please list two emergency contacts with phone numbers.