Volunteer Personnel Form: Contact Information

Volunteer Personnel Form
(All information will be treated confidentially. Please answer all questions as completely as possible. The use of this form does not necessarily indicate that volunteer positions are open nor does it constitute an offer or a contract of placement.)
CONTACT INFORMATION
Last Name Home Address: Street Home Phone Employer Name First City Mobile Phone Address State Middle Zip Code Email Business Phone
EMERGENCY CONTACT
Name Address Relationship to You Telephone
STATISTICAL INFORMATION (Optional: only used for Red Cross purposes)

Gender: Female Male Ethnicity: Date of Birth: Veteran: Yes No
EXPERIENCE: Please list paid and volunteers experience. Optional: please also attach a resume.
1. Organizational Name Supervisor:
Title Held:
2. Organizational Name Date (from/to) Supervisor:
Title Held: Telephone
Date (from/to)
Telephone
Brief job description:
Brief job description:
RED CROSS EXPERIENCE

Have you ever worked for the Red Cross: Title Held/Responsibilities ___ Yes, as a volunteer Location ___ Yes, in a paid position ___No Dates (from/to)
EDUCATION/TRAINING/ LICENSES
Name of Institution High School College Other Please list any current professional licenses (e.g. RN, EMT, Mental Health), including Red Cross authorizations. License Type Number State Expiration Date Location Degree or Certificate
LANGUAGE SKILLS
Please list languages (other than English) including sign language, indicating proficiency levels as Basic, Conversational, Working Knowledge, Professional Knowledge, or Native Speaker. LANGUAGE: Proficiency in: Speaking: Writing: LANGUAGE: Proficiency in: Speaking: Writing: LANGUAGE: Proficiency in: Speaking: Writing:
(OVER)
REFERENCES: Please list two to four references that know your qualifications or experience. Do not list relatives.
1.
Name Address Relationship Telephone 3. Name Address Relationship Telephone
2.
Name Address
Relationship Telephone
4. Name Address
Relationship Telephone
OTHER INFORMATION: (The answer to any of these questions will not necessarily disqualify an applicant.)
Are you licensed to operate a motor vehicle in Massachusetts? Yes No Have you ever been convicted (1) of a felony; (2) of a misdemeanor, which was not a first offense for drunkenness, simple assault, speeding, moving traffic violations, affray or disturbing the peace, where the date of such misdemeanor conviction or the completion of any period of incarceration resulting there from, whichever date is later, occurred within the last five (5) years? Yes No Record How did you hear about Red Cross volunteer opportunities? Is there anything else youd like to tell us?
VOLUNTEER OPPORTUNITIES
Please mark your interests and the areas convenient for you. Not all activities are available in all locations.
Disaster Relief
Disaster Action Team Member Disaster Caseworker Community Disaster Instructor Disaster Nurse
Health & Safety

Instructor First Aid Stations Test Proctor
Youth Programs
Youth Mentor College Club High School Club School Ambassador Youth Leadership Council General Volunteering
International Social Services

Tracing/Caseworker
Others
Sales & Marketing Public Relations Fundraising/Special Events Holiday Toy Program
Quincy Waltham
Agency Support
Receptionist/Administrative
Boston Brockton
Hunger Relief
Food Pantry
Fall River Melrose
New Bedford
Peabody
AVAILABILITY
Please mark the time you are available. Monday ____Morning ____Afternoon ____Evening Tuesday ____Morning ____Afternoon ____Evening Wednesday ____Morning ____Afternoon ____Evening Thursday ____Morning ____Afternoon ____Evening Friday ____Morning ____Afternoon ____Evening Saturday ____Morning ____Afternoon ____Evening Sunday ____Morning ____Afternoon ____Evening
VOLUNTEER CONSENT FOR REFERENCE AND BACKGROUND CHECKS

I do hereby give the American Red Cross of Massachusetts Bay permission to enquire into my education, references, driving record, employment, volunteer history, or police record. I further give permission to the holder of any such records to release the same to the American Red Cross of Massachusetts Bay. I hereby hold the American Red Cross of Massachusetts Bay harmless of any liability, whether civil or criminal, that may arise as a result of the release of this information about me. I further hold harmless any individual, agency, business, or corporation that provides information or documents to the American Red Cross of Massachusetts Bay. I understand that the American Red Cross of Massachusetts Bay will use this information as part of its verification of my volunteer application. I further understand that as a Red Cross Volunteer, I am not paid for my services. An applicant with a sealed record on file with the commission of probation may answer no record with respect to any inquiry relative to prior arrests, court appearances, and adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution.
Name of Applicant (please print) X Signature of Applicant & Date
Name of Parent/Guardian if under 18 years of age X Signature of Parent/Guardian & Date
Please return this application to: ARCMB, Volunteer Services, 285 Columbus Ave. Boston, MA 02116 Visit us on the web at http://www.bostonredcross.org (Rev. 2004)
XARCMB FE062 The American Red Cross of Massachusetts Bay is certified by the Criminal History Systems Board for access to conviction and pending criminal case data. As an applicant/employee for the position of _______________________________, I understand that a criminal record check will be conducted for conviction and pending criminal case information only and that it will not necessarily disqualify me. The information below is correct to the best of my knowledge. __________________________________________/____/____/____ Applicant/Employee Signature/Date APPLICANT/EMPLOYEE INFORMATION (PLEASE PRINT) __________________ LAST NAME ____________________ FIRST NAME __________________ MIDDLE NAME
_______________________________________ MAIDEN NAME OR ALIAS (IF APPLICABLE) DATE OF BIRTH:_____________SOCIAL SECURITY NUMBER:_______-_____-________ ADDRESS: ________________________________ ________________________________ ________________________________ REQUESTED BY:______________________________________/____/____/_______ SIGNATURE OF CORI AUTHORIZED EMPLOYEE / DATE ____________________________________________________________ CHSB USE ONLY RECORD ATTACHED:_________________ NO RECORD:____________
CODE OF CONDUCT
INTRODUCTION
The American Red Cross is a charitable not-for-profit organization dedicated to providing service to those in need. The American Red Cross has traditionally demanded and received the highest ethical performance from its employees and volunteers. In an effort to maintain the high standard of conduct expected and deserved by the American public and to enable the organization to continue to offer services required by those in need, the American Red Cross operates under the following Code of Conduct, applicable to all volunteers and paid staff.
CODE OF CONDUCT No employee or volunteer member shall: 1. Authorize the use of or use for the benefit or advantage of any person, the name, emblem, endorsement, services, or property of the American Red Cross, except in conformance with American Red Cross policy. 2. Accept or seek on behalf of himself or any other person, any financial advantage or gain of other than nominal value, which may be offered as a result of the volunteer's or paid staff's affiliation with the American Red Cross. 3. Publicly utilize any American Red Cross affiliation in connection with the promotion of partisan politics, religious matters, or positions on any issue not in conformity with the official position of the American Red Cross. 4. Disclose any confidential American Red Cross information that is available solely as a result of the volunteer's or paid staff member's affiliation with the American Red Cross to any person not authorized to receive such information, or use to the disadvantage of the American Red Cross any such confidential information, without the express authorization of the American Red Cross. 5. Knowingly take any action or make any statement intended to influence the conduct of the American Red Cross in such a way as to confer any financial benefit on any person, corporation, or entity in which the individual has a significant interest or affiliation. 6. Operate or act in any manner that is contrary to the best interests of the American Red Cross. In the event that the volunteer's or paid staff's obligation to operate in the best interests of the American Red Cross conflicts with the interests of any organization in which the individual has a financial interest or an affiliation, the individual shall disclose such conflict to the American Red Cross upon becoming aware of it, shall absent himself or herself from the room during deliberations on the matter, and shall refrain from participating in any decisions or voting in connection with the matter. CERTIFICATION I, __________________________________, certify that I have read and understand the Code of Conduct of the American Red Cross and agree to comply with it. I affirm that, except as listed below, I have no financial interest or affiliation with any organization, which may have, interests that conflict with, or appear to conflict with, the best interests of the American Red Cross. Should such conflicts or apparent conflicts of interest arise in connection with the affiliations listed below, I agree to refrain from participating in any deliberations, decisions or voting related to the matter. I also agree, during the term of my affiliation with the American Red Cross, to report promptly to the supervisor of my unit, or his/her designee, any future situation that involves, or might appear to involve, me in any conflict with the best interests of the American Red Cross. Date Name Signature ________________________________________________________________ ________________________________________________________________
______

Volunteer Personnel Form: Contact Information

Uploaded by

Copyright:

Available Formats

Volunteer Personnel Form: Contact Information

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Volunteer Personnel Form: Contact Information

Uploaded by

Copyright:

Available Formats

Volunteer Personnel Form

STATISTICAL INFORMATION (Optional: only used for Red Cross purposes)

2. Organizational Name Date (from/to) Supervisor:

Title Held: Telephone

Brief job description:

Brief job description:

RED CROSS EXPERIENCE

Health & Safety

International Social Services

VOLUNTEER CONSENT FOR REFERENCE AND BACKGROUND CHECKS

Name of Applicant (please print) X Signature of Applicant & Date

Name of Parent/Guardian if under 18 years of age X Signature of Parent/Guardian & Date

You might also like