STC Volunteer Application

STC Volunteer Application
In order for us to use your skills and talents wisely, please complete the application as thoroughly as possible. All fields followed with a red asterisk (*) MUST be filled in. After receiving your completed application, we will screen, interview, and place volunteers into positions throughout our Orange County locations where volunteers' knowledge and expertise can best be utilized. If you are selected to fill one of our positions you can expect to hear from our staff.

We do offer non-paid, credit internsips for positions listed in this form. If you are interested to intern with us, please fill out this application including the additional note section for the internship request.

If you have any volunteering or internship question, please email volunteer@straighttalkcounseling.org.

Thank you for your interest in volunteering with Straight Talk Clinic!
Volunteer's Information
Full Name *

First Name Last Name
Current Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Primary Contact Number *

Area Code Phone Number
Email Address *
iwant2volunteer@myemail.com
Are you 18 years or older? *

Yes No
List previous volunteer experience(s)
Volunteer Opportunities
How did you hear about our volunteer opportunities?

STC Website Online Search Social Media Friends & Family
Indicate areas of interest. Check all that apply. *

Administration Computer / IT Contents Editing Data Entry Event Committee Event Planning Fundraising Grant Research Graphics Design Outreach / Marketing Photography / Video Social Media Translator Volunteer Coordinator Volunteer Coordinator - Campus Web Design / Maintenance
The objective(s) you wish to achieve through voluntary works.

Personal growth Learn new skills/knowledge Enhance employment potential Contribute to the communities Explore new career field Meet people
If you are interested in our internship opportunities, please briefly explain.
Do you need this for college credit?

Yes No
Availability for Volunteering
Anticipated Volunteer Start Date *

Month Day Year

Please indicate the days and times that you are generally available to serve. *

Number of Hours Available to Volunteer Each Week: *
References

Please provide at least two (2) references from people who know you. References may include supervisors, coworkers, faith leaders, teachers, coaches, mentors or any others who know you well. Do not list relatives/household members.

	Name	Phone Number	Email Address	Relationship
1
2
3

Background Check Authorization
I certify that the information in this Volunteer Application is true, correct and complete to the best of my knowledge. I authorize Straight Talk Clinic to verify any and all information I provided by contacting appropriate sources. I understand that for the protection of visitors, volunteers and staff, all adults (age 18 and up) must voluntarily authorize a background check and I hereby authorize such background check.

I give Straight Talk Clinic permission to investigate any job-related information that I have provided in my application, resume, or during the interview process, including all of the items check:
Employment History Professional References Criminal Records Educational History Licenses and/or certifications if required Motor Vehicle records if position requires use of company vehicle
Social Security Number *
Date of Birth *

Month Day Year
I understand that Straight Talk Clinic may order a consumer report to obtain this information, and I authorize the release of that report to Straight Talk Clinic.

I release form liability any individual, company, institution or agency that provides information that I have authorized to be released about me. I waive my right of privacy with respect to the background information listed above and agree to hold Straight Talk Clinic and its agent harmless from any liability from the results of its investigation or actions taken on the results.

I understand that I have a right under the "Fair Credit Reporting Act" to obtain a copy of my report by directing a written report request to Straight Talk Clinic. I may also obtain a copy of this report my checking the yes box at the bottom of this disclosure. I further understand that I have a right to request a complete and accurate disclosure of the nature and scope of the report by directing a written request to Straight Talk Clinic.
Waiver and Release of Liability
In consideration of being allowed to intern or volunteer my services at Straight Talk Clinic, I hereby acknowledge that there are certain risks of injury involved, and I knowingly and freely assume all such risks and assume full responsibility for my participation. To the extent allowed by law, I agree to indemnify and hold harmless Straight Talk Clinic, its officers, employees, agents, representatives and volunteers, of all liabilities and all loss or damage to person or property which may occur or be incident to my involvement or participation.
Volunteer Confidentiality and Non-Disclosure Agreement
I recognize that as an intern or volunteer of Straight Talk Clinics, I may have access to confidential information concerning Straight Talk Clinic, its guests, clients, agents, employees, volunteers or representatives. In consideration of any volunteer or internship status with Straight Talk Clinic, I agree I will not at any time, during or after volunteering for Straight Talk Clinic, divulge or reveal to any person, firm, or corporation, any information (including, but not limited to, personal or financial information or client lists), directly or indirectly, which might in any way be used to injure or interfere with the business of Straight Talk Clinic, or to alienate guests, clients, agents, employees, volunteers or representatives from Straight Talk Clinic or to cause discontent or dissatisfaction among any such persons.

I agree that should I have any questions as to the propriety of release of any information, I will request clearance from Straight Talk Clinic prior to releasing such information.

The Straight Talk Clinic ("STC") and Volunteer/Intern acknowledge that Volunteer/Intern, in performing the terms and conditions of Volunteer/Intern's, will directly or indirectly gain access to information about Straight Talk Clinic and its operations, including, but not limited to, its modes and methods of conducting its business and marketing its services, its Volunteer/Interns, clients, funders, sponsors, contributors, donors, supporters, vendors and referral/contributor source lists, its trade secrets, its copyrighted and non-copyrighted or non-protected computer software programs, files, its techniques of operation, its financial structure, and its weaknesses, if any (hereinafter referred to as "Confidential Information").

Straight Talk Clinic and Volunteer/Intern acknowledge and agree that all Confidential Information shall be deemed to be highly confidential. Volunteer/Intern agrees not to disclose, communicate, reveal or divulge, in any way, any Confidential Information to any person or entity not employed by Straight Talk Clinic or one of its affiliates, unless the Executive Director has given advance written approval to such communication. Even if authorized, in no event shall Confidential Information be disclosed or communicated, revealed or divulged by Volunteer/Intern to any person or entity who is not a Straight Talk Clinic Volunteer/Intern, if Volunteer/Intern could reasonably foresee that such communication would adversely affect Straight Talk Clinic's business.

Upon termination of volunteering with Straight Talk Clinic for any reason, or at any other time Straight Talk Clinic demands, Volunteer/Intern shall deliver promptly to Straight Talk Clinic all material, property (computer, cell phone, communication hardware, name badges, etc.), and documentation relating to Straight Talk Clinic, including without limitation all memoranda, notes, records, reports, files, manuals, agency reference binders, drawings, blueprints, Volunteer/Intern lists, client lists, referral lists, vendor service lists, software, programs, and other documents, whether or not of a confidential nature, belonging to Straight Talk Clinic, including all copies of such materials which Volunteer/Intern may then possess or have under Volunteer/Intern's control. Volunteer/Intern further agrees that upon termination, Volunteer/Intern shall not retain any document or data of any description containing or pertaining to the Confidential Information.

Volunteer/Intern agrees to maintain, protect and keep secure any and all Confidential Information pertaining to Straight Talk Clinic and to not disclose any of this information to any third parties.

Volunteer/Intern hereby acknowledges and agrees that it is important for Straight Talk Clinic's operations to protect and preserve its Confidential Information; Straight Talk Clinic reserves the right to question its Volunteer/Interns, generally and specifically, regarding Confidential Information.

Volunteer/Intern agrees that the terms of this Confidentiality and Non-Disclosure Agreement shall survive termination of Volunteer/Intern's employment, whether that termination is voluntary or involuntary.
Acknowledgement
I certify that the information contained in this application is correct to the best of my knowledge. I certify that I have not knowingly withheld any information that might adversely affect my chances to volunteer and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that an omission or misstatement of material fact on this application or on any document used to secure a volunteer opportunity shall be grounds for rejection of this application, regardless of the time elapsed before discovery.

Straight Talk Clinic is committed to providing a safe and productive environment for our staff members and clients. To achieve that goal, we conduct background checks for all final candidates being considered for volunteerism/internship. Background checks may include, but are not limited to, criminal history, national sex offender search, and motor vehicle history.

In the event of a volunteer assignment, I understand that false or misleading information given in my application or interview may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the organization.

I understand that:
- In the course of volunteering for Straight Talk Clinic, I may be dealing with confidential information and I agree to keep said information in the strictest confidence.
- The relationship between Straight Talk Clinic and volunteers is an “at will” arrangement, and it may be terminated at any time without cause by either the volunteer or Straight Talk Clinic.
- If appointed, my position is conditional upon Straight Talk Clinic receiving no inappropriate information on my background.
- Regardless of previous appointments, Straight Talk Clinic is not obligated to appoint me to a volunteer position.
- I am applying for a volunteer position and not as an employee; accordingly I would not be covered by any employee benefits, workers’ compensation or other status as an employee.
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STC Volunteer Application

Volunteer's Information

Volunteer Opportunities

Availability for Volunteering

References

Background Check Authorization

Waiver and Release of Liability

Volunteer Confidentiality and Non-Disclosure Agreement

Acknowledgement