Section One - Personal Information First Name: Last Name: Address: City: State: Zip Code: Cell Phone: Other Number: Email Address: Group, School or Work Affiliation:
Minor's Birthdate: (mm/dd/yyyy)
In case of emergency, contact: Name: Phone Number: Relationship:
1. Work Experience Current or Most Recent Employer: Occupation: Are you currently employed? Yes No Part-time Retired
2. Education Are you a student? Yes No Name of school: Grade Level:
3. Volunteer Experience Where have you volunteered in the past? What do you hope to gain from volunteering at the Freestore Foodbank?
What activities or abilities would you be interested in sharing or doing at the Freestore Foodbank?
Check Out Power Pack, Duck & Hunger through Kroger stores Clothing Distribution with the Back on Track Program Clerical Support (data entry, file management, typing, photocopying…) Food Distribution through the Food Room: stocking shelves, assisting customers Gardening/Working on the farm at the Giving Fields Hospitality for clients and visitors through reception desk and registration at events Maintenance and building projects, painting, landscaping, cleaning… Organization and Leadership for Boards, Committees or Special Projects Photography at events and during volunteer activities Selling ducks/event tickets Solicit sponsors/in-kind donations Translator Special Events: set up & tear-down Special Events: coordination/team leader Special Events: general operations Training and educating other volunteers Transportation: I am willing to drive my own vehicle for delivery Transportation: I have a valid BC driver’s licenses Volunteer Engagement: Make phone calls, present at volunteer fairs Warehouse Distribution: packing food boxes, sorting food Writing articles for newsletters, internet site and proposals Other Other:
1. What days/hours are you available to volunteer? Please check. MON TUES WED THURS FRI SAT MORNING AFTERNOON EVENING
2. How long are you hoping to volunteer at the Freestore?
3. Are you volunteering to fulfill community service hours or other requirements? If yes, please explain.
Directions: Check mark to the left of each statement indicating you agree with its content.
Confidentiality Statement You agree that Agency/Client information is to be considered confidential and proprietary. You will not disclose, publish or otherwise reveal any information that can be identified as such without written authorization by the Freestore Foodbank.
Drug Free Workplace Policy The Freestore Foodbank is committed to providing and maintaining a safe working environment for all employees. This includes maintaining a drug free workplace to protect our employees, customers, and others by providing the highest level of service, and minimize the risk of accidents and injuries. The Freestore Foodbank’s Drug Free Workplace policy is intended to comply with all state laws governing drug testing and is designed to safeguard employee and volunteer privacy rights to the fullest extent of the law.
Waiver of Liability The Freestore Foodbank accepts volunteer placements through various resources. Some assignments involve strenuous and/or physical labor including, without limitations, lifting and climbing. I acknowledge my receipt of permission to volunteer for the Freestore Foodbank. I also acknowledge my understanding that my service as a volunteer on or about Freestore Foodbank’s properties or as a volunteer at the Freestore Foodbank special event may expose me to various risks of injury or illness. In consideration of the permission and privilege allowed to me to serve as a volunteer, I agree and understand that I freely assume all risks, hazard, injury, illness, property damage and/or losses which may befall me in connection with my exercise of the permission and privilege allowed to me by Freestore Foodbank, and I agree not to hold the Freestore Foodbank, its agents, employees or volunteers liable for risk, hazard, injury, illness, property damage and/or loss. I understand that this Waiver and Release of Liability extends to and applies to any personal injuries, injurious results, damage or losses which I may experience or sustain while engaged in training for volunteer service or while engaged in serving as a volunteer for the Freestore Foodbank. I promise for myself, my estate, executor, heirs and assigns not to sue or initiate any claim procedure against Freestore Foodbank, its agents, employees, volunteers, assigns, or successors with respect to any risk, hazard, loss, injury, illness or property damage I may experience or sustain arising directly or indirectly out of my volunteer activities with or at the Freestore Foodbank.
Background Check Authorization I acknowledge that certain volunteer opportunities will require a Background Check Authorization in order to be considered for that placement. Background checks are usually completed when volunteers work with sensitive information or when given leadership responsibilities as volunteers. You will be requested to provide your date of birth, social security number, and driver’s license.
Signature: (type your full name) Date: