Step 1 of 6 16% PhoneThis field is for validation purposes and should be left unchanged.Volunteer InformationName:* First Last Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone:*Email:* I would like to receive emails about CSS volunteer opportunities:* Yes No Birth Date:* MM slash DD slash YYYY Are you completing Community Work Service hours?* Yes No CSS no longer accepts volunteers seeking court-ordered Community Work Service (CWS) hours. Please check the programs(s) with whom you wish to work:*Some programs may not have open volunteer positions available. We will notify you of future openings for program areas you're interested in if no positions are currently available. Agency Staff Behavioral Health Services Brother Francis Shelter Clare House Complex Care Fresh International Gardens/Grow North Farm Refugee Assistance and Immigration Services St. Francis House Food Pantry Third Avenue Resource Navigation Center (3RNC) Other Other:*BFS Open Volunteer Positions* BFS Meals Team Monthly Slots Foot Care Clinic Listening Post Clare House Open Volunteer Positions* Clare House Meals Team Monthly Slots Clare House Donation Sorting Clare House Front Desk Support Complex Care Open Volunteer Positions Listening Post Fresh International Gardens (FIG) Open Volunteer Positions FIG Child Enrichment Activities Farm Mentor SFH Open Volunteer Positions SFH Food Packer SFH Delivery Driver RAIS Open Volunteer Positions* RAIS Meal Team Volunteer FIG Child Enrichment Family Mentor RAIS Youth Mentor English Tutor Professional License (if any):Days and times you prefer to volunteer:How did you hear about volunteer opportunities with CSS? CSS Volunteer/Employee School Newspaper Church Friend/Relative United Way Website Other Other:Why do you want to volunteer at CSS? Please share any specific interests or volunteer opportunities you're interested in.* Emergency Contact:* First Last Emergency Contact Phone:*Emergency Contact Relationship:*Have you ever been convicted of a felony?* Yes No Please explain:* I certify that all the information contained in this application is true and correct to the best of my knowledge. I hereby authorize and empower Catholic Social Services or persons employed on their behalf to investigate all statements contained in this application. I hereby release any and all individuals who provide information in response to any inquiry from Catholic Social Services or its employees under this release from any and all claims by me or through me, either known or unknown, which may arise from providing information covered by this release. I understand that should my application be accepted, my services will be provided on a strictly volunteer basis and that I will not be compensated for my services. I understand and agree that I will not be an employee of Catholic Social Services. I understand and agree that Catholic Social Services or I may terminate my volunteer services at any time. I agree to abide by all rules and policies adopted by Catholic Social Services for volunteers.Acceptance of Application Statement* I certify that I have read, fully understand, and accept all terms of the Applicant Statement. Statement of ConfidentialityOne of the most important aspects of Catholic Social Services is confidentiality of information pertaining to clients, employees, volunteers and donors of CSS, as well as agency information. Careful attention to the individual’s right to privacy is required by Catholic Social Services and professional standards. Maintaining the confidentiality of the clients, employees, volunteers and donors of Catholic Social Services is essential for the protection of the agency, clients, employees, donors, staff and volunteers. I understand that the clients, employees, volunteers and donors of Catholic Social Services are entitled to the utmost regard and respect. I will therefore conduct myself in a friendly and professional manner at all times with the well being and privacy of the individual in mind during all personal interactions. Without a signed release or permission from the respective individual, I will not release the name of a client, employee, volunteer or donor nor discuss any incident encountered or observed at any agency program except to authorized staff members or other agencies as required by law. This is to include any and all incidents and/or statements of sexual or physical abuse of minors, and any incidents and/or statements indicating suicidal or homicidal intentions, except as required by law. Maintaining agency information as confidential is vital to the agency, as well as a matter of professionalism. I agree that any agency information which is not made public will be kept confidential, unless I am specifically given permission by management to release such information.Acceptance of Statement of Confidentiality* I certify that I have read, understand and agree to abide by Catholic Social Services Statement of Confidentiality as outlined above. Acceptance of Weight Lifting Disclaimer* Volunteers may be required to lift at least 30 pounds in certain positions. Media ReleaseWith permission, Catholic Social Services would like to use photos, videos, or recordings of volunteers for fundraising and promotional activities. Please read this statement of release and give or withhold permission for us to use photos, videos, or recordings of you and your family.Statement of Release: I hereby grant Catholic Social Services the right and permission to use and/or publish my or my family members’ photograph, voice, artwork, creative writing and/or image in any media or fundraising purpose for promotion of Catholic Social Services’ programs, advertising or other lawful purpose. Media will be defined to include photographic, audio, visual, electronic, or combined recordings of CSS facilities, clients and staff in any medium in which a likeness, voice, or discussion may be recorded in print, audio or visual, electronic or display. Media includes newspapers/magazines (articles and advertising), radio (audio recordings), television (live and/or video recordings); print media such as brochures, newsletters, etc.; other electronic media such as web sites on the Internet; and other visuals such as displays. Fundraising will be defined as activities coordinated, sponsored or endorsed by the agency to generate or solicit funds from the community. I hereby waive any right to inspect or approve the finished product or the advertising text that may be used in connection therewith, or the use to which it may be applied. I release, discharge, and agree to hold harmless Catholic Social Services, or its program, from any liability by virtue of any use whatsoever of said photographs or images.May we use photos, videos, or recordings of you or members of your family? Yes, I give permission for CSS to use my likeness. No, I do not give permission for CSS to use my likeness. Permission to Perform Background Check(s)Volunteers are not required to pay for background checks, however because of the cost of background checks ($22-$75) and the volume of checks we perform, you have the option to make a charitable donation to CSS to help offset the cost. The volunteer manager will perform a background check once you have submitted this application packet. Depending on which program you are volunteering in, this may include: State of Alaska Court Records National Sex Offender Database Pinnacle Background Check Fingerprinting & Alaska Background Check Unit Please select an option for background check payment:* CSS to pay for background check I would like to make a monetary donation to CSS to offset the cost of my background check This donation is tax deductible.Select the background check you would like to cover with your donation:* Pinnacle Background Check Fingerprinting and Alaska Background Check Unit The Pinnacle Background Check is required for all regular volunteers. The Fingerprinting and Alaska Background Check Unit is required for Brother Francis Shelter Caring Clinic volunteers. Total $0.00 Credit Card* I hereby authorize the obtaining of "consumer reports" and/or ''investigative consumer reports" by the Company at any time after receipt of this authorization and throughout my volunteer work, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency,institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Pinnacle Investigations, 1101 N. Argonne, Suite A201, Spokane Valley, WA 99212, 800·955~5306, www.pinnacleprof.com, another outside organization acting on behalf of the Company, and/or the Company itself. I agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as the original.Permission to Perform Background Check(s)* I certify that I have read, understand and agree to the Background Check as outlined above. Δ