Volunteer at Hope House Hope House Northern Colorado Volunteer Application The information you provide on this application will be used in determining your suitability for a volunteer position with Hope House. We greatly appreciate your assistance in getting to know you. A suggested donation of $17.00 to cover your background check is greatly appreciated. Please make checks out to Hope House Northern Colorado or visit our donation web page for credit card donations.* I'd like to make the donation to cover this cost. I'd prefer not to donate at this time. Please Note: Your Social Security Number is required for background checks and will be requested in person. Hope House will not store or save your Social Security Number once the background check is complete. Personal Information Today's Date MM slash DD slash YYYY Name* First Middle 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 Previous Street Address: (if less than 1 year at current 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 Cell Phone Number*Home Phone NumberWork Phone NumberEmail Address* Birth Date* MM slash DD slash YYYY Relationship Status Married Divorced Single Widowed Spouse's Name Spouse's Occupation Name/Age of children How did you hear about Hope House?* Have you ever been a volunteer before?* Yes No When and where have you volunteered? Why would you like to volunteer at Hope House with teen moms? *Are you willing to make a 6 month commitment to Hope House?* Yes No Do you have professional training we should have knowledge of? Yes No If you attend church, what church do you attend? Do you own a business or provide a service you can donate to our Silent Auction? Examples include: a gift certificate to my bakery, a weekend in my mountain vacation condo, dinner for two at my restaurant, use of my Avalanch tickets for one game Your Driver’s License Number* State* Has your driver’s license ever been suspended or revoked?* Yes No If yes, please explain Do you have proof of Auto insurance?* Yes No Personal References Please use non-family members only. Reference 1 - Name* Relationship (to Reference 1) Daytime Phone Number (Reference 1)Email (Reference 1) Reference 2 - Name Relationship (to Reference 2) Daytime Phone Number (Reference 2)Email (Reference 2) Reference 3 - Name Relationship (to Reference 3) Daytime Phone Number (Reference 3)Email (Reference 3) Emergency Contact Information Emergency Contact Name* Emergency Contact Phone Number:*Relationship to Emergency Contact* Employment Information Current Employer Work Phone NumberWork 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 Current Position/Duties: Further Information What has given you the greatest satisfaction?What has been the biggest disappointment?Describe your support systemHow do they feel about your volunteering and the time it will require?Describe your temperamentAre there any areas of the ministry or working with teen moms that concerns you or makes you feel uncomfortable?What is your current state of health?Do you have a physical impairment that we should be aware of?What do you want to get out of a volunteer experience?Policies, disclosures and releases Please read the following policies, disclosures and releases, and digitally sign and date each one. I agree with all of the statements listed below: • I hereby affirm that all the information provided is true to the best of my knowledge. I understand that any false information or misleading information on the application will be grounds for this application process to be terminated. • I understand that any information obtained by Hope House during the application process will remain confidential. • I understand that additional training may be required before I can start volunteering at Hope House. • Photo release – I understand I may be asked to share my experiences or use my photo for any fundraising events or marketing materials at Hope House, whenever appropriate.Digital Signature: Type your name here if you agree to the statements above*Date* MM slash DD slash YYYY HOPE HOUSE NORTHERN COLORADO DRUG AND ALCOHOL POLICY Hope House Northern Colorado is committed to the well-being of our employees and volunteers, to the safety of the workplace, and to the provision of high-quality services to our clients. For all of these reasons, we cannot tolerate the unlawful possession, use, manufacture, distribution, or dispensation of controlled substances in the workplace or during work time. Moreover, employees and volunteers must come to work free from the influence of alcohol, illegal drugs, and unlawfully used prescription medications. As a condition of employment, Hope House Northern Colorado requires applicants take a drug test (urinalysis) at, or near the time of their employment. Any employee or volunteer who violates this restriction will be subject to disciplinary action, up to and including termination. Under federal law, any employee or volunteer who is convicted of a criminal drug statute violation occurring in the workplace must notify his/her employer or supervisor of the conviction within 5 days. Hope House does not wish to interfere with its employee’s or volunteer’s legitimate medical needs, but recognizes that even legitimately prescribed medication could affect an employee’s or volunteer’s ability to work safely. Accordingly, each Hope House employee or volunteer is expected to inquire of her physician whether a prescribed medication could affect her ability to work safely. If the physician indicates that the medication will affect the employee’s or volunteer’s ability to work safely or the medication bears a warning label indicating that the medication may have such an effect, the employee or volunteer must notify their supervisor. The manager will then determine whether the employee’s or volunteers duties should be modified in any manner.Digital Signature: Type your full name here if you have read and agree to abide by the above Drug and Alcohol policy*Date* MM slash DD slash YYYY HOPE HOUSE NORTHERN COLORADO CHILD ABUSE REPORTING POLICY Under the "Child Protection Act of 1987" (C.R.S. 19-3-301) in Colorado Children’s Code, child care center workers are required to report suspected child abuse or neglect. The law at 19-3-304 states that if a child care worker has "reasonable cause to know or suspect that a child has been subjected to abuse or neglect or who has observed the child being subjected to circumstances or conditions which would reasonably result in abuse or neglect shall immediately report or cause a report to be made of such fact to the county department or local law enforcement agency." “Abuse” or “child abuse or neglect” means an act or omission in one of the following categories which threatens the health or welfare of a child: skin bruising, bleeding, tissue swelling, or death; any case in which a child is subjected to sexual assault or molestation, sexual exploitation, or prostitution; any case in which a child is in need of services because the child’s parents, legal guardian or custodian fails to take the same actions to provided adequate food, clothing, shelter, medical care, or supervision that a prudent parent would take. If at any time a staff member or volunteer reasonably suspects child abuse, it is the responsibility of the staff member or volunteer to report the suspected abuse in an incident report to her manager. The manager will work with the Executive Director and/or Program Director to submit a report of this suspicion to the local county department of social or human services at (303) 271-4357 or the police department. It is not staff’s or volunteer’s role to investigate suspected abuse- only to report it. Persons who make a good faith report are immune from civil and criminal liability. Additionally, the law provides for the protection of the identity of the reporting party. A child care worker who fails to report suspected child abuse or neglect commits a class 3 misdemeanor and will be punished as provided in section 18-1-106, C.R.S. The staff personal could also be liable for damages “proximately caused thereby.” I have read and understand the above requirements concerning my responsibility regarding child abuse reporting.Digital Signature: Type your full name here if you have read and agree to abide by the above Child Abuse Reporting policy*Date* MM slash DD slash YYYY HOPE HOUSE NORTHERN COLORADO CONFIDENTIALITY POLICY As an employee or volunteer you will perform services for Hope House Northern Colorado which may require that confidential and proprietary information may be disclosed to you. Confidential information is any information of any kind, nature, or description concerning matters affecting or relating to your services, the business or operations, processes or other data of Hope House Northern Colorado. Accordingly, to protect Hope House Northern Colorado’s confidential information that will be disclosed, you agree as follows: 1.To not discuss confidential matters related to teen moms, donors, co-workers, volunteers, or board members with anyone (including, but not limited to friends, spouses, domestic partners, relatives, etc.) except as required in the course of the employee’s or volunteers work by a court order or other legal mandate. All information in etapestry and the donor data base is confidential. 2.To describe the work here in only the most general terms, talking about the "population" here, their situation in general, and your function in general. 3.To not use the names or other specific details about clients or volunteers (without that volunteer’s specific permission). 4.To hold all confidential information received from Hope House of Colorado in strict confidence and exercise a reasonable degree of care to prevent disclosure to others. 5.The location of Hope House’s Residential Program is confidential. Information as to its whereabouts should only be disclosed to teen moms, vendors and other outside parties as is absolutely necessary. This does not pertain to the Resource Center. 6.Your confidentiality contract is with Hope House, and you are not authorized to extend that contract to anyone else. 7.Violations of confidentiality are considered very serious and will not be tolerated. Breach of confidentiality may result in immediate termination of employment.Digital Signature: Type your full name here if you have read and agree to abide by the above Confidentiality policy*Date* MM slash DD slash YYYY HOPE HOUSE NORTHERN COLORADO DISCRIMINATORY HARASSMENT POLICY It is a violation of Hope House Northern Colorado policy to harass anyone at work because of his or her race, color, age, religion, veteran status, sex, disability, national origin, creed, or ancestry. Hope House Northern Colorado is committed to maintaining a workplace that is free of any such harassment. If you believe that you have been subject to discriminatory harassment by a co-worker, supervisor, volunteer, client, vendor, or by anyone else during the course of your employment or volunteering, please report your concerns immediately to a member of the Human Resources Department, your manager or the Executive Director. Retaliation against an employee or volunteer by any person under Hope House Northern Colorado’s control for opposing such harassment, for filing a bona fide complaint of discriminatory harassment or for providing information in good faith regarding another employee's or volunteer’s complaint, will not be tolerated. Once a complaint of discriminatory harassment has been filed, an investigation will be conducted. The nature and extent of the investigation will depend upon the complaint. The intent is to obtain further information about the events/conduct complained of, to enable the person(s) named in the complaint to tell their side of the story, to determine whether discriminatory harassment has in fact occurred, and to develop an appropriate resolution. You may be asked to put your complaint in writing, or the person with whom you discuss your complaint might take notes and ask you to sign them. All employees and volunteers are expected to cooperate with any Hope House Northern Colorado-sponsored investigation of a complaint of discriminatory harassment, upon the request of the Human Resources Department, their manager or the Executive Director. Any employee or volunteer who is determined to have committed discriminatory harassment or retaliation or who fails to cooperate with a Hope House Northern Colorado-sponsored investigation of discriminatory harassment or retaliation will be subject to disciplinary action, up to and including termination.Digital Signature: Type your full name here if you have read and agree to abide by the above Discriminatory Harassment policy*Date* MM slash DD slash YYYY HOPE HOUSE NORTHERN COLORADO SEXUAL HARASSMENT POLICY Hope House Northern Colorado is firmly committed to maintaining a positive working environment and a workplace which is free of inappropriate conduct, including offensive verbal and written communication of a sexual nature. Sexual harassment is defined as unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute sexual harassment when: (a) submission to such conduct is made (explicitly or implicitly) a term or condition of the individual's employment or volunteer involvement (b) submission to or rejection of such conduct is used as the basis for volunteering or employment decisions affecting the individual; or (c) such conduct has the purpose or effect of creating an intimidating, hostile, or offensive working environment. Any employee or volunteer who feels he/she may have been subject to sexual harassment or inappropriate sexual conduct should take the complaint directly to a member of the Human Resources Department, their manager or the Executive Director. Complaints will be promptly investigated and appropriate action will be taken against the offender.Digital Signature: Type your full name here if you have read and agree to abide by the above Sexual Harassment policy.*Date* MM slash DD slash YYYY HOPE HOUSE NORTHERN COLORADO ABUSE OR MOLESTATION PREVENTION POLICY All Hope House employees and volunteers must treat the teen moms and their children with respect and model self-control. If staff, parents, or volunteers observe abusive behaviors by Hope House staff or volunteers, they are to follow the procedures below. Abusive behaviors are defined as neglectful treatment, physical or sexual actions that are intended or could be expected to injure, or methods of limiting a child’s behavior, which could harm or endanger the teen mom or her child. Operational Procedures: 1.All suspected abuse by a Hope House employee or volunteer when alleged by a child or parent must be reported immediately to the Executive Director, 303-669-1319. Parents are also encouraged to contact the Child Abuse Hotline directly at 303-271-4357 or 303-271-4131. 2.All suspected abuse alleged by another Hope House employee or volunteer member must be reported immediately to the Program Director or the Executor Director. If the Program Director is the first point of contact, she will inform the Executor Director that there is a suspected case of abuse by a staff member. Staff will gather information to determine if a call to Human Services is needed. 3.If the determination is made that Human Services is to be contacted, the reporting party must initiate the call. When an investigation is initiated, the appropriate supervisor or coordinator will be notified. Human Services may determine that the case needs to be turned over to the City of Arvada Police Department or Jefferson County Sheriff’s Department for investigation. If that is the determination, the Executive Director must be contacted immediately and an internal investigation will be conducted. 4.The person alleging the abuse has the responsibility for making a report to the Department of Human Services. The Program Director and/or the Executive Director will follow up directly with the individual staff member or volunteer. 5.If the Department of Human Services initiates an investigation, the Program Director and/or the Executive Director will meet with the employee’s or volunteers direct supervisor and the employee or volunteer to review the circumstances. The employee may be placed on leave with or without pay pending the outcome of the investigation. The volunteer’s privileges at Hope House may be suspended pending the outcome of the investigation. 6.After an investigation of the charges is completed, the results of the investigation will be reviewed by the Executive Director and the Program Manager. If disciplinary action is necessary, it can include suspension from the job with or without pay and further action up to and including termination of the employee. A volunteer’s association with Hope House may be suspended or terminated.Digital Signature: Type your full name here if you have read and agree to abide by the above Abusse or Molestation Prevention policy.*Date* MM slash DD slash YYYY WAIVER/RELEASE OF LIABILITY In consideration of being allowed to volunteer my services at Hope House Northern Colorado, I hereby acknowledge that there are certain risks, some involving injury and I knowingly and freely assume all such risks and assume full responsibility for my participation. To the extent allowed by law, I agree to release, discharge, indemnify and hold harmless Hope House Northern Colorado, its officers, employees, agents, representatives and volunteers, of all liabilities and all loss or damage to person or property which may occur or be incident to my involvement or participation. Digital Signature: Type your full name here if you have read and agree to abide by the above Waiver/Release of Liability policy.*Date* MM slash DD slash YYYY VOLUNTEER CODE OF CONDUCT Hope House has some general "Rules of Thumb" when working with our teen moms. We ask that all volunteers adhere to these practices and accept the consequence of termination should these procedures be violated. Please refrain from discussing teen mom matters with anyone outside of Hope House staff or counselors. Hope House does not permit any teen mom to move into the home of a volunteer. Volunteers should help teen mom adhere to Hope House rules & policies. Teens may not use your cell phone unless it relates to HH business. All volunteers of Hope House should respect the opinions of others with regard to religion, adoption, parenting, politics, sexual orientation, etc. Please do not force your opinion on any teen mom. Physical boundaries are set for both you and the teen mom. Please ask first - about giving them or their children a hug or kiss. Please don’t be offended if they say “no”. Understand boundaries – not sharing your lives in detail. You are here to serve. Hope House asks that you not loan money to any teen mom. The lending of any other type of item is discouraged and is completely at his/her own risk and Hope House has no responsibility. Hope House keeps track of the volunteer hours for several different reasons. Please sign in and out of Hope House your volunteer hours for grant writing purposes. Volunteers should refrain from behavior that reflects badly upon them or the organization. We are held to a higher standard regarding sexuality, flirting, swearing, drugs/alcohol use etc. Hope House’s good reputation depends on YOUR good behavior. Please act accordinglyDigital Signature: Type your full name here if you have read and agree to abide by the above Volunteer Code of Conduct.*Date* MM slash DD slash YYYY BACKGROUND CHECK Hope House is excited about your joining our organization and looks forward to a beneficial and productive relationship. Nevertheless, you should be aware that your volunteer assignment with Hope House is for a minimum of a 6 mos. Hope House reserves the right to conduct background investigations and/or reference checks on all its potential volunteers. Your volunteer position, therefore, is contingent upon a clearance of such a background investigation and/or reference check. At the volunteer orientation, you will be asked to provide us with your social security number and sign a waiver that allows Hope House to conduct a background check and or/MVR.