Step 1 of 7 14% Volunteer InformationName:* First Last Address:* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone:*Email:* Birth Date:* Date Format: MM slash DD slash YYYY Are you completing Community Work Service hours?*YesNoCSS no longer accepts volunteers seeking court-ordered Community Work Service (CWS) hours. Where did you most recently volunteer?When did you most recently volunteer?Please check the programs(s) with whom you wish to work: Brother Francis Shelter Clare House Refugee Assistance and Immigration Services St. Francis House Food Pantry Other Other:Please check any special skills or interests: Arts and Crafts Fundraising Media/Graphic Arts Donation Drives Administrative/Office Support Constructions/Carpentry Professional License Children's Activities Gardening Other Other:Professional License: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: What are your expectations as a Catholic Social Services volunteer?*What are you hoping to get out of your volunteer experience at CSS?*Why are you choosing to volunteer with CSS?* Emergency Contact:* First Last Emergency Contact Phone:*Emergency Contact Relationship:*Have you ever been convicted of a felony?*YesNoPlease 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. 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 checkI would like to make a monetary donation to CSS to offset the cost of my background checkThis donation is tax deductible.Select the background check you would like to cover with your donation:*Pinnacle Background CheckFingerprinting and Alaska Background Check UnitThe 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 American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name 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. CommentsThis field is for validation purposes and should be left unchanged.