Volunteer Application (one application per person)

Date

MonthDayYear

Name*

First NameLast Name

Spouse's name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail

Home Number

Area CodePhone Number

Cellular Number

Area CodePhone Number

Work Number

Area CodePhone Number

Work status

Occupation

Education: Degree/diploma obtained:

Area of Study

Date of Birth

MonthDayYear

Gender

Shirt Size

Ethnicity (optional): may choose more than one

Church Name

Church City & State/Prov

Denomination

Church Address

Church City & State

Church Zip/PC

Who/what most influenced you to apply for this volunteer work? Select only one.

Can provide lodging, if needed

Length

Number of slides

Do you grant permission for use of any photo taken of you for promotional activities?

YesNo

I would like to receive the volunteer newsletter, the Spotlight, 3 times a year via:

EmailPostal Mail

Person(s) to contact in case of emergency:

Emergency Contact #1

Relationship

Phone Number

Emergency Contact #2

Relationship

Phone Number

References: List two persons other than relatives and pastors.

Reference #1

Email

Phone

Reference #2

Email

Phone

Why are you volunteering to work with this Christian organization?

Availability: When are you able to volunteer. Specify preferred dates.

Skills & Experience

According to the following guidelines, plase rank ONLY those skills that apply to you, by selecting the number in the space provided (for example 421 Painter 3)

1 Can work only with close guidance of a skilled person

2 Can work alone, but with some guidance

3 Can work confidently and independently in this area

4 Skilled in this area and can guide or teach others

5 Am Licensed/Certified in this area or field

401 Building Estimator

402 Home Builder

403 Carpenter

404 Finish Carpenter

405 Rough-in/Framer

406 Bricklayer/Mason

409 Concrete Worker

412 Drywall Hanger

413 Drywall Taping/Mudding

414 Ceiling Texturing

415 Electrician

416 Siding Installer

418 Carpet Installer

419 Vinyl Floor Installer

420 Laminate Installer

421 Painter

422 Ceramic Tile

423 Plumber

425 Roofer

429 Heating & Cooling

430 Rapid Response/Debris Removal

433 General Assistant

434 Vehicle Maintenance

436 Mobile Home Repair

506 Food Prep/Baking/Cooking

507 Group Food Preparation

508 Housekeeping/Cleaning

511 Needs Assessment

512 Prayer Support

601 Office Support

605 Business Manager

606 Clergy

607 Farmer

608 Heavy Equipment Operator

609 Manager/Supervisor

610 Musician

611 Nurse

612 Nurses' Aide

613 Photographer

614 Physician

615 Secretary

616 Videographer

617 Teacher

618 Truck Driver (valid CDL)

619 Grant Writer

620 Presenter/Speaker

621 Fund Raiser

626 Chaplain

627 Journalist

632 Community Organizer

633 Social Worker

639 Negotiator/Mediator

701 Accountant/Bookkeeper

702 Attorney

712 Computer Programmer

713 Computer/Data Processor

Other Skills?

Languages: 1 = Speak 2 = Read 3 = Write 4 = Translate

Spanish

Other Languages?

From the list above, my primary interests are:

Please check the following boxes; indicating you agree with each statement.*

I am committed to the Christian faith and willing to support the Christian Reformed Church in North America's (CRCNA's) mission which states: "As people called by God, we gather to praise god, listen to Him and respond. We nurture each other in faith and obedience to Christ. We love and care for one another as God's people. We commit ourselves to serve and to tell others about Jesus. We pursue God's justice and peace in every area of life."To the best of my knowledge, and recent physician's report (within the past 2 years), I am capable of performing the duties that match my skills and interests. I am emotionally stable, flexible and adaptable in order to work in demanding and diverse situations. I understand this information will be shared as needed to ensure safe, appropriate assignments.I am willing to have a complete physical and/or appropriate immunizations as required for a specific assignment.I understand that funding varies from one opportunity to another, I may have to cover some or all of my own expenses.I understand that it is a policy of the CRCNA and World Renew to obtain a background check before I can volunteer. I also understand that it is my responsibility to obtain this background check and pay any costs associated with this. The cost of the background check is minimal. World Renew will send the instructions on obtaining the background check once my application has been received.I certify that the information contained in this application is true and accurate.

Limitations, if any (such as epilepsy, diabetes, dizziness, heart condition, etc)

Please check the following boxes; indicating you have read the following statements:*

US DISCLAIMER: Unless staff is notified by phone or ail, volunteers may receive future mailings for volunteer opportunities and/or CRCNA programs and campaigns.CANADIAN PRIVACY STATEMENT: The information provided by the Applicant in this form will be used to assess the suitability of the Applicant for placement in available volunteer roles and, when possible, to place volunteers in demographically appropriate roles. This information will also be used to update Christian Reformed Church constituency records, which include mailing lists pertaining to the Christian Reformed Church and its agencies/ministries. The information provided by the applicant in this form will only be used for this purposes and will not be disclosed to third parties except in furtherance of these purposes or as required by law.RELEASE OF LIABILITY: I acknowledge and understand that there are significant elements of Risk in connection with the volunteer activities that I will be performing, and that serious injuries or illness occasionally occur to persons performing these services. By signing below, I am agreeing to (i) ASSUME ALL RISKS AND (ii) WAIVE AND RELEASE ANY AND ALL CLAIMS, DEMANDS, AND CAUSES OF ACTION, INCLUDING FOR PERSONAL INJURY, ILLNESS, PAIN, SUFFERING, ECONOMIC DAMAGES AND NON-ECONOMIC DAMAGES, that I have experienced and/or migh experience in the future (whether known, unknown, anticipated, unanticipated) as a result of my participating in volunteer or services on behalf of World Renew or its partner agencies, and/or affiliates. For purposes of this waiver and release, World Renew shall include World Renew, its affiliates and their officers, directors, employees, agents, volunteers, individual clients and property owners where volunteers are housed, or where work is performed. This waiver and release apply to me and to any person who could make a claim on my behalf, including without limitation, my heirs, beneficiaries, personal representatives, and next of kin. This Agreement and this Release are governed by Michigan law. In the event that any provision is found invalid, then that provision will be automatically amended in as minimal a manner as possible to make the provision valid. This is the entire agreement and any oral or other terms are excluded. I HAVE READ THE TERMS OF THIS AGREEMENT, UNDERSTAND IT, AND ENTER INTO IT VOLUNTARILY.

Concise Code of Conduct-Please check the following boxes indicating you have read the following statements.*

1. Introduction: World Renew (WR) staff, partner staff, volunteers, consultants and other associated personnel, are personally and collectively responsible for upholding and promoting the highest ethical and professional standards in their work. This Concise Code of Conduct (or an approved equivalent) must be signed by all personnel engaging with World Renew work as outlined in the World Renew Code of Conduct Policy. This includes, but is not limited to, staff of partners implementing WR funded projects, partner staff working on DRS project sites, volunteers, consultants and suppliers.2. Standards of behavior: I agree to the following standards of behavior: i. Dignity and non-discriminationI will respect and promote fundamental human rights without discrimination and will not use humanitarian or development assistance, or advocacy programs, to further a particular religious or partisan political standpoint. I will make my decisions on the basis of needs and make no adverse distinction on the basis of race, creed, nationality, gender, religious belief, class or political opinion. I will treat all people with whom I work fairly, with respect, courtesy, and dignity, and according to international and local laws and standards. ii. Prevention of Sexual Exploitation and Abuse- Recognizing World Renew’s zero-tolerance policy for sexual exploitation and abuse, I will help create and maintain an environment that prevents sexual exploitation, abuse of power and any other forms of abuse. I will never exploit the vulnerability of any target group or abuse a position to withhold development or humanitarian assistance. I will never give preferential treatment in order to solicit sexual favors, gifts, payments of any kind, or advantage and I will never engage in sexual relationships with members of crisis-affected populations. I will never exchange money, employment, goods or services for sex, including sexual favors or other forms of humiliating, degrading or exploitative behavior. iii. Anti-harassment-I will never commit any act or form of harassment which results in physical, sexual or psychological harm or suffering to individuals, especially vulnerable adults and children. I will never engage in any behavior, deliberate or otherwise, that makes the recipient feel persecuted, vulnerable or powerless. iv. Child Safeguarding- Understanding World Renew’s commitment to safeguarding children, I will promote a culture in which children are treated with dignity and respect and will follow practices that minimize the risk of abuse or accidental harm to children. I will never engage in any sexual activity with children (persons under the age of 18) regardless of the age of majority or age of consent locally. I will never condone or participate in behavior with children which is unsafe, abusive or illegal. v. Anti-Fraud & Corruption- Recognizing World Renew’s zero-tolerance policy for fraud and corruption, I will declare any known or potential conflicts of interest to my supervisor, and I will never steal, misuse or misappropriate World Renew funds or property, ensuring that financial and other resources are used solely for their intended purpose. I will never use or accept a bribe in the form of money, goods and/or services. vi. Ethical Business Practices-Recognizing World Renew’s commitment to ethical Business Practices, I will conduct all business in accordance with internationally accepted practices and procedures and uphold the highest standards of accountability and transparency in relation to finances, management and governance. I will strive for the highest health and safety standards in all aspects of my work and I will never use illegal labor, child labor and/or forced labor. vii. Safety & Security-Understanding the importance of my actions on the safety and security of myself and others around me, I will adhere to relevant safety and security policies and procedures in my context. I will never use, or have in my possession, any weapons or ammunition of any kind while on duty and I will never operate a vehicle under the influence of alcohol, drugs or any illegal substance. I will never drink alcohol or use any substance in a way that affects my ability to carry out my role, or that impacts on the reputation of World Renew. viii. Data Security-Understanding the risks related to the misuse of personal data and images, I will always seek to obtain written, informed consent of individuals when taking a photograph or film and explain the general way in which it will be used. For children, consent from a parent/guardian is also required. I will always ensure that personal information collected from communities and crisis affected populations is kept safe, secure and confidential. ix. Environmental Stewardship-Recognizing World Renew’s commitment to creation stewardship, and the associated programmatic strategies of environmental stewardship, resilience and restoration, I will consider the impact of my work on the environment and use resources in an environmentally responsible way.3. Obligation to Report: I will report immediately any knowledge, concerns or substantial suspicions of breaches of this Code of Conduct to my WR contact/supervisor/complaints focal point or by email to complaints@worldrenew.net4. Signature I, the undersigned, confirm that I have read and understood the contents of the World Renew Concise Code of Conduct and I accept the consequences of any violation of any of the provisions under this Code of Conduct. I understand that breaching this Code of Conduct constitutes grounds for disciplinary measures, up to and including termination of employment and/or services. Knowingly withholding information about any reports, concerns or substantial suspicions of breaches to this Code of Conduct also constitutes grounds for disciplinary measures.

Signature

Signature*

Signature date*

Signature indicating approval of parent/legal guardian of applicant is less than 18 years of age.