Volunteer Application

THE O’TAHIRAH FOUNDATION, INC VOLUNTEER APPLICATION

Please fill out and return by

Email: volunteers@otahirah.org

or by mail: The O’Tahirah Foundation, Inc Volunteer Coordinator

P.O. Box 8033 Chandler, AZ

YesNo

SURVIVORS CHRISTMAS TOY DRIVE ONLY

SHOPPINGGIFT WRAPPINGSORTINGSURVIVOR'S RENAISSANCECHRISTMAS DAY DELIVERY
YesNo

*The following questions are OPTIONAL and asked so that your volunteer placement will be appropriate for you.

YesNo

Office Use Only

EmailedFaxed

AVAILABILITY

Days Times

VOLUNTEER POSITIONS

INTERNSHIP CLERICAL WORKDOMESTIC VIOLENCE ADVOCATEPROFESSIONAL SERVICESPREVENTION AWARENESS TOURSCORPORATE PREVENTION AWARENESS ADVOCATES

CONFIDENTIALITY AGREEMENT

As a condition of being involved with persons who are receiving service from The O’Tahirah Foundation, Inc. I agree not to divulge any information obtained in the course of such involvement. I am committed to protecting the confidentiality of personal health and non-health related in formation relating to any volunteer, employee, and/or client of The O’Tahirah Foundation, Inc. Disclosure of information will not be to anyone outside the organization without the person’s written consent, and disclosure within the organization will only be to authorized personnel on a need to know basis only. I recognize that the unauthorized release of confidential information may make me subject to a civil action under provisions of the welfare and institutions code.

agree to protect the physical and electronic information relating to an employee and/or client as stated in The O’Tahirah Foundation, Inc policies and procedures. I also realize that The O’Tahirah Foundation, Inc. recognizes the confidentiality of my records.

I understand that any breach in confidentiality may precipitate immediate dismissal and/or legal action.

Signature

(Hold down your left mouse button and draw a digitized signature.)

Date

FINGERPRINT CLEARANCE AGREEMENT

In SOME cases, volunteering at The O’Tahirah Foundation, Inc will require volunteers to obtain an FBI background check. As a potential volunteer, I give my permission for The O’Tahirah Foundation, Inc to conduct a background check through the Arizona Department of Public Safety and I agree to pay for any DPS costs to complete the investigation*. I also understand that any information obtained in the course of the investigation will remain confidential, and should I be denied a clearance that I will immediately discontinue my volunteering at The O’Tahirah Foundation, Inc or request a volunteer position that does not require a clearance.

*Note: You will be notified if the position you're applying for will require a background check.

Signature

(Hold down your left mouse button and draw a digitized signature.)

Date

VOLUNTEER AGREEMENT AND WAIVER

In consideration of the opportunity afforded me to participate in The O’Tahirah Foundation, Inc VOLUNTEER PROGRAM, I hereby agree to the following:

  • • I understand that volunteer workers have voluntarily agreed to assist in the program, and will notbe paid for their services, and that no medical insurance or workers compensation benefits will be provided by The O’Tahirah Foundation, Inc.
  • • The volunteer is not obligated to perform the volunteer services applied for.
  • The O’Tahirah Foundation, Inc is not obligated to assign him/her volunteer work.
  • • I respect the right of The O’Tahirah Foundation, Inc to dismiss any volunteer for such reasons as poor performance, poor attendance, and unwillingness to accept direction, violation of any state or federal law, disregard for volunteer policies and/or procedures, etc.
  • • The volunteer will complete all necessary orientation, screening and training required by The O’Tahirah Foundation, Inc.
  • • The volunteer will become familiar with The O’Tahirah Foundation, Inc volunteer policies and procedures and uphold their philosophy and standards.
  • • The volunteer will not contact The O’Tahirah Foundation, Inc clients outside of the agreed upon time of work at the assigned facility, nor give personal information (address, phone #, etc.) to The O’Tahirah Foundation, Inc clients.
  • • I understand and authorize that my application, reference forms, and interview responses may be shared with the facility in which I choose to volunteer. I understand that although the agency respects the confidentiality of volunteer records, it must retain the right to disclose information received when, in the agency’s opinion, such disclosure would be in the best interest of the client.
  • • I understand that The O’Tahirah Foundation, Inc uses photos of volunteers in a variety of activities for recruiting and promotional reasons. I am willing to support their efforts. The O’Tahirah Foundation, Inc has my permission to use my name, photos, audio and video recordings, interviews in connection with television, radio, print and/or social media. I also understand I have the privilege of refusing such at any time.
  • • I understand that in connection with activities associated with the programs, I might be exposed to personal bodily damage or damage to my property. With full knowledge of the potential dangers involved, I, on behalf of myself, my assignees, heirs, guardians, and legal representatives, agree to assume any and all risks of property damage, personal injury or death. I hereby voluntarily and fully waive, relinquish, and release any and all rights, claims or causes of action against The O’Tahirah Foundation, Inc, it’s agents, employees, officers, and directors, the suppliers, sponsors, and volunteers to the programs, collectively and individually.
  • I acknowledge the foregoing and am aware that this is a release of liability by placing my initials here:
  • I, the undersigned, have carefully read this agreement and fully understand its contents and sign it of my own free will.
  • Name (Please print):