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Required fields are marked with an asterisk (*). First Name *
Last Name *
Address *
City *
State *
Zip *
Phone *
Date of Birth *
A valid date as MM/DD/YYYY (for example: 11/30/2015)
What is the best way to contact you? *
Age *
What type of volunteer position are you interested in? *
What area(s) are you interested in volunteering? *
Faith Community/Civic Group/Corporate Affiliation
Emergency Contact *
Relationship to Emergency Contact *
Emergency Contact Phone *
How did you hear about Arlington Life Shelter *
What is your reason for wanting to volunteer with the Arlington Life Shelter *
Please list each Volunteer Experience in the space provided below.
Name of Organization/Location/Dates/Position Title and Basic Responsibilities *
Please list each Employment Experience in the space provided below
Employer/Location/Dates/Job Title and Responsibilities *
Education and/or Certification (please list any degrees and/or certifications you have received as well as when and where they were completed *
Race/Ethnicity
Age Group (Must be at least 18 to volunteer)
I certify that all information provided on this application is true and that I have not knowingly withheld any information which might affect my application unfavorably. I understand that any misrepresentation of facts on this application may be consider *
Electronic Signature *
Date Application Completed *
A valid date as MM/DD/YYYY (for example: 11/30/2015)
As a voluntary participant in programs offered and administered by the Arlington Life Shelter, I, the undersigned, as one of the conditions of my participation, specifically release the Arlington Life Shelter, its officers, directors and employees from any claims by the undersigned or liabilities to the undersigned of any kind, whatsoever, involving but not limited to those claims which are actual or contingent presently asserted or yet to be asserted known or unknown arising from or related to my participation in those activities of the Arlington Life Shelter. In addition, I agree to indemnify, defend and hold harmless the Arlington Life Shelter, its officers, directors and employees from and against any claim by their parties or liabilities to third parties of any kind whatsoever caused by my negligent acts.
Waiver of Liability and Hold Harmless Initials *
Volunteers for the Arlington Life Shelter (ALS) serve as unpaid staff for ALS and therefore, represent the agency when engaged in activities relevant to their volunteer service.
When acting as a representative of the agency, volunteers are expected to conduct themselves in such a way as to promote the goals and objectives of ALS. Special attention should be given to the following areas of concern with regard to conduct:
• Volunteers should treat all residents, other volunteers and staff of ALS with respect and dignity and should demonstrate the ability to see one’s own values and beliefs as not necessarily better or worse than another’s values and beliefs. Disrespect towards residents, volunteers or staff members will not be tolerated.
• Volunteers shall be free of anti-social, legal, substance abuse or other problems that would negatively impact or impede the execution of volunteer duties.
• Arlington Life Shelter prohibits sexual harassment of a volunteer, resident or employee by employees or volunteers. (See definition of Sexual Harassment.)
• Volunteers involved in direct services to residents are discouraged from establishing a personal relationship with any resident to include providing money, personal items, transportation or a personal phone number, Exceeding boundaries of the professional relationship jeopardizes the ability to represent ALS and to provide quality services and may result in the termination of volunteer service.
• Volunteers involved in religious activities must review and sign a separate Religious Activities Guidelines. Proselytizing is prohibited.
I understand that violation of one or more of these guidelines for conduct may result in the termination of all volunteer activities at the Arlington Life Shelter.
Code of Conduct for Volunteers Initials *
Criminal background checks are required of all volunteers and employees of the Arlington Life Shelter. All information is confidential.
I hereby give my permission for the Arlington Life Shelter to obtain information relating to my criminal history record. The criminal history record, as received from the reporting agencies, may include arrest and conviction data as well as plea bargains and deferred adjudication and delinquent conduct committed by a juvenile. 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 with the agency, the criminal history records check may be repeated at any time. I understand that I will have an opportunity to review the criminal history as received by the Arlington Life Shelter and a procedure is available for clarification if I dispute the record as received.
Consent for Criminal Background Check Authorization/Waiver/Indemnity *
It is the policy of the Arlington Life Shelter that there shall be no harassment of any employee, volunteer, contractor or client on account of that person’s race, color, religion, sex, sexual orientation, age, disability or any legally-protected characteristic. All volunteers are expected to abide by this policy. Any volunteer who violates this policy will be subject to disciplinary action, up to and including discharge.
Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute “sexual harassment.” Any volunteer who feels that she/he has been harassed should immediately report the matter to the Community Engagement Manager or Executive Director.
I, the undersigned, do, for myself, my heirs, executors and administrators, hereby remise, release and forever discharge and agree to indemnify any reporting agency, and each of their officers, directors and all employees, and agents and hold them harmless from and against any and all causes of actions, suits, liabilities, costs, debts, and sums of money, claims and demands whatsoever (including claims of negligence, gross negligence, and/or strict liability), and any and all related attorney’s fees, court costs, and other expenses resulting from the investigation of my background in connection with my application to become a Volunteer/Staff Member.
Sexual Harrassment Initials *
Group leaders are required to sign that they have read these guidelines and will share them with their group members prior to providing service at the Arlington Life Shelter.
In order to remain in compliance with funding sources and maintain a calm and structured environment for our residents, we require that:
• Participation in religious activities is optional for the residents.
• Activities must end by 9:00 p.m. unless a time expansion has been approved by the Community Engagement Manager.
• The planned activity and group participants must remain in the designated area. Hallways and room entrances are to remain open and clear for passage.
• All faith-oriented activities should be “middle of the road.” Laying on of hands, anointing, laying on the floor, speaking in tongues, etc. is not appropriate for the shelter environment.
• Faith messages should be positive in nature and presented as opinions. Negative, condescending, belligerent, or forced opinions will not be tolerated.
• No amplifiers, microphones, speakers or loud equipment may be used.
• Participatory activities using music, singing, drama, puppetry are greatly encouraged.
• Interaction with residents is greatly encouraged.
• Written information can be placed on tables for residents to pick up as they desire. Materials cannot be directly distributed to residents not participating in the activity.
I have read and understand the religious guidelines set forth above. I agree that all of my group members will abide by these guidelines during our services to the residents of the Arlington Life Shelter and understand that a lack of adherence to the guidelines could result in cancellation of the activity.
Religious Activities Guidelines Initials *
I understand that I will learn personal information about the agency clients as well as other volunteers in the course of my work as a volunteer. I understand that this information is to be held in the strictest of confidence and is not to be discussed with anyone other than staff of the Arlington Life Shelter or other volunteers who have taken similar vows of confidentiality. I, therefore, pledge to keep the aforementioned information confidential as a condition of my volunteering and I realize that breach of this pledge is grounds for immediate termination from the volunteer program.
Pledge of Confidentiality Initials *
