Individual Volunteer Application
(Enter all aliases, including maiden name, if applicable, in the section below.)
Where were you born?
Your Educational History
(Select last year completed)
PLEASE ATTACH A PHOTO COPY OF YOUR DRIVER’S LISCENSE OR STATE-ISSUED I.D. TO THIS APPLICATION.
- If you have had chicken pox or the vaccine, 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 or the vaccine, you must be vaccinated and wait one month before entering the house.
Please list the names, email, and/or phone number 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 phone number 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 from Casa de Esperanza.
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.
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:
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.
Statement of Risk and Precaution Expectations
Casa de Esperanza is concerned that the health, safety and welfare of our staff, volunteers, community foster parents, and the children placed in our care be protected to the greatest extent possible. We invite you to join in this concern, to offer suggestions, reports and comments wherever and whenever you believe that these will aid in protecting the health safety and welfare of all concerned. We expect you to act responsibly in all matters where your own health condition, your actions, and your observations may affect the health, safety, or welfare of you and the Casa de Esperanza Community.
Employees, volunteers and community foster parents working or interacting with a child placing agency such as Casa de Esperanza may be exposed to communicable illnesses common to young children, covering the entire spectrum from minor illnesses to major ones: measles, pertussis, chickenpox, hepatitis, pink eye, lice, etc. Because children may come to Casa de Esperanza without detailed, complete, or accurate health history information, it is often difficult or impossible to evaluate the risk of exposure to illness associated with any individual child. Because children cared for by Casa de Esperanza often come from households in crisis situations and may have been victims of abuse or neglect, they may have received inadequate health care prior to coming to Casa de Esperanza. For this and other reasons, they may be at higher risk than the general population of children for exposure to serious communicable illnesses such as HIV, venereal disease, hepatitis, CMV (a virus that could affect an unborn child), COVID-19 or other emerging viruses.
As we are concerned about the welfare of our staff, volunteers, and community foster parents as well as their families and unborn children, we provide a training and education program to inform you about matters including appropriate hygiene techniques and universal precautions. When these techniques and precautions are followed, the risk of contracting communicable diseases can be greatly reduced. To help protect you and your loved ones, your colleagues, and the children in our care, it is extremely important that you learn to practice, and implement appropriate hygiene techniques and health precautions. Techniques and precautions may include such basic measures as thoroughly washing hands after caring for a child or using a diluted bleach solution or other disinfecting solution to clean up waste matter. Other interventions such as the use of disposable gloves, face masks, or other recommended protective wear when caring for a sick child or handling body fluids may also be appropriate or advised depending on the situation. With certain illnesses, such as COVID-19, risk factors may further be reduced by the choices you make both individually and as a member of the larger Casa de Esperanza community. For example, choosing to wear a mask when out in public, avoiding crowds and practicing social distancing of a minimum of six feet may further protect you and the children in your care from COVID-19. While we cannot eliminate all health and safety risks associated with being a part of the Casa de Esperanza community, being informed, aware, and utilizing recommended protocols and precautions can significantly reduce risk factors for our community. We expect our Casa de Esperanza community to adhere to such practices.
Certification, Release and Authorization Form
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.