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Individual Volunteer Application

Full Name:

Alternative names:
(Enter all aliases, including maiden name, if applicable, in the section below.)

Driver’s License:

Address:

Where were you born?

Are you volunteering through the Junior League?

Spouse’s name:

Your Educational History
(Select last year completed)

Do you have any physical limitations that may prevent you from performing the volunteer job for which you are applying?

Are you able to lift and carry children up to 20 pounds?

Have you had Chicken Pox?

  • If you have had chicken pox, then you are fine to go into a Casa House.
  • If you are unsure if you have had chicken pox, you must have a titer test. If this proves that you are immune, you are fine to go into a house. If it proves that you are not immune, then you must be vaccinated and wait one month before entering the house.
  • If you have not had chicken pox, you must be vaccinated and wait one month before entering the house.
PLEASE ATTACH A PHOTO COPY OF YOUR DRIVER’S LISCENSE OR STATE-ISSUED I.D. TO THIS APPLICATION.

 

 

References

Please list the names, email, and/or mailing address of four (4) non-family members who have known you for a minimum of 3 years that we may contact for references. In addition, we will need the name, email, and/or mailing address of one family member to also be used as a reference. There is no need for you to request letters from these individuals, however, you may wish to inform them to expect an email/ mailing from Casa de Esperanza.

Name:

Confidentiality Statement

If selected to volunteer with Casa de Esperanza, I agree to maintain the confidentiality of all client, volunteer and donor information.

I understand that if my volunteer application is denied, I will be notified of this decision in writing. I also understand that if denied, the reason(s) for this decision are completely confidential and that Casa de Esperanza staff members are not permitted to discuss them with me. I also understand that the same policy applies to termination.

 

Casa de Esperanza
Volunteer Applicant Questionnaire

This form has been designed for all volunteer position applicants – even if you do not intend to volunteer directly with the children. All information provided by you will be used to determine how you might best assist the agency and the children and families we serve. Please be prepared to discuss any of the following questions during your personal interview.

Will you have a problem working with HIV+ or chronically ill children?

By signing below, I am confirming that I have thoroughly reviewed and answered the above “Volunteer Applicant Questionnaire” with honesty and to the best of my ability.

 

Volunteer Availability and Preference

Please check the areas where you would like to serve Casa de Esperanza

 

For your information, scheduled house volunteer times are generally available every day of the week as follows. (Afternoon and evening hours may be adjusted to match the needs of individual houses.) Please select your preferred day and time:

Sunday Monday Tuesday Wednesday Thursday Friday Saturday
9:30 am – 12:30 pm
2:30 pm – 5:30 pm
5:30 pm – 8:30 pm

 

Demographic Information

Casa de Esperanza de los Ninos, Inc., is a 501(c)(3) non-profit organization, which receives all funding from private sources. To assist us in identifying possible funding and volunteer recruitment sources, we ask that you complete the following section.

Does either employer support any philanthropy with funding, time, donations, etc?

Does either employer sponsor an “Employer Matching Gifts Program?

Does your religious organization have a mission/outreach/giving program?

 

Certification, Release and Authorization Form

CERTIFICATION
I certify that all statements made by me, including in my application, questionnaire and interview are true, complete and correct to the best of my knowledge and belief, are made in good faith, and that I have withheld nothing that would, if disclosed, affect this application unfavorably.

AUTHORIZATION FOR RELEASE OF INFORMATION
I hereby give Casa de Esperanza de los Ninos, Inc. permission to contact my present employer(s), associates, educational institutions, law enforcement agencies, and other individuals and agencies deemed necessary in determining my eligibility for volunteer service.

CRIMINAL BACKGROUND HISTORY SCREENING: CONSENT FOR CRIMINAL BACKGROUND HISTORY CHECK AUTHORIZATION/WAIVER/INDEMNITY

I hereby give my permission in exchange for good and valuable consideration for Casa de Esperanza de los Niño’s, Inc. to obtain information relating to my criminal history record through criminal record agencies. The criminal history record, as received from the reporting agencies, may include arrest and conviction data as well as plea bargains and deferred adjudication. I understand that this information will be used, in part, to determine my eligibility for an employment/volunteer position with this organization. I also understand that as long as I remain an employee or volunteer here, the criminal history records check may be repeated at any time. I understand that I will have an opportunity to review the criminal history and a procedure is available for clarification, if I dispute the record as received.

GENERAL RELEASE OF LIABILITY

On behalf of myself and my heirs, executors and administrators, I hereby release, discharge, and forever hold harmless Casa de Esperanza, the Center and each of their agents, employees, representatives, and directors, from all liability, costs or damages resulting from the investigation of my background in connection with my application to become a volunteer. I agree not to sue Casa de Esperanza,or any of their agents, employees, representatives, or directors, for any claim or cause of action related to or based upon this investigation. If accepted as a volunteer, I hereby agree to abide by all rules and policies of Casa de Esperanza, as explained in the Volunteer Orientation Manual, including any amendments that may be made from time to time. I also agree to notify Casa de Esperanza, immediately in the event that I am indicted for a felony or crime of moral turpitude. I will be advised if a criminal match is reported on my criminal history investigation and Casa de Esperanza has no responsibility to clarify or resolve the matter on my behalf.

My signature indicates that I have read and fully understand the above consent and release.