461Mt.SupportRoad,POBox660,Lebanon,NH03766 -(603)643-2298

VolunteerApplication

Name:

Phone(Home):(Work):

(Cell):Email:

MailingAddress:PhysicalAddress:

City/Town:State:ZIP:

CurrentEmployer(Name/Contactinfo):

PriorBusinessExperience:

PriorVolunteerExperience:

HowdidyoubecomeinterestedinDavid’sHouse?

Doyouhaveanyphysicallimitationsweshouldbeawareof?

Areyouvolunteeringaspartoforthroughabusiness,schoolgroup,orotherorganization?Ifso,whichone?

VolunteerOpportunities

Pleasecirclethevolunteeropportunitiesthatinterestyou.

1.HospitalityVolunteer:Mustbeatleast18yearsofageorateenagerwithadultsupervision.Aminimumcommitmentoftwo-hourshiftsmonthlyispreferred,butflexiblehoursareavailable.Training(~11/2hours)andorientation(withanothervolunteer)arerequired.Dutiesinclude:Registerguests,answertelephoneandmiscellaneousactivitiestomaintainthehousefortheguests.Managethehousewhenstaffisnotonduty(eveningsandweekends).Pleasecheckgeneralavailabilitybelow:

Sun / Mon / Tues / Wed / Thur / Fri / Sat
Mornings
8AM-12PM
Afternoons
12PM–4PM
EarlyEvenings
4PM–6PM
Evenings
6PM–9PM

2.EventVolunteer–Helpwithfundraisingandawarenessactivities.

3.Cook–Prepareamealforguests,eitherhereoratyourhouse.

4.Baker–Preparebakedgoodsforguestsorforevents,eitherhereoratyourhouse.

5.SpecialProjects–Avariety!Includeanythingfromdataentrytomaintenance.

6.OtherInterests/Skills:

Besttimeofdaytocontactyou:PreferredMethod:

References:(Giveatleasttwowithaddressandphonenumber)

1.

2.

3.

ConfidentialityStatement

Iunderstandthatthisisanapplicationfor,andnotacommitmentorpromiseof,volunteeropportunity.IcertifythatIhaveandwillprovideinformationthroughouttheselectionprocess,includingonthisapplicationandininterviewswithDavid’sHouse,thatistrue,correctandcompletetothebestofmyknowledge.

IcertifythatIhaveandwillansweranyquestionthatwouldunfavorablyaffectmyapplicationforavolunteerposition.IunderstandthatinformationcontainedonmyapplicationmaybeverifiedbyDavid’sHouse.IunderstandthatmisrepresentationoromissionsmaybecauseformyimmediaterejectionasanapplicantforavolunteerpositionwithDavid’sHouseormyterminationasavolunteer.

IunderstandandsupportthemissionofDavid’sHouseandagreethatanyinformationIreceive,directlyorindirectly,regardinganyguest,willbekeptinstrictconfidence.Breachesofconfidentialitywillbecauseforimmediatedismissal. Shouldsuchaterminationoccur,IunderstandthatmyobligationtoprotecttheconfidentialityofboththeguestsandorganizationalinformationwillcontinueafterterminationofmyrelationshipwithDavid’sHouse.

IagreetoholdDavid’sHousestaff,directors,guests,andvolunteersharmlessintheeventofanaccidentorinjurysustainedbymewhileperformingmyvolunteerservice.IagreethatIwillnotusemyvehicletotransportguestsatanytimeforanyreason.

IagreetoauthorizeanationalbackgroundcriminalandchildabusecheckwiththecosttobepaidbyDavid’sHouse:

DateofBirth:SocialSecurity#--

Ifacceptedasavolunteerhere,IagreethatIammakingacommitmenttoserveandwillcontactDavid’sHouseatonceifIdiscoverthatIcannotkeepascheduledtime commitment.

ApplicantSignatureDate

Employee/VolunteerEmergencyContactForm

Name:

PersonalContactInfo:

HomeAddress

City,State,ZIP

HomePhoneCellPhone

EmergencyContactInfo:

(PRIMARYCONTACT)

NameRelationship

HomeAddress

City,State,ZIP

HomePhoneCellPhone

WorkPhoneEmployer

(SECONDARYCONTACT)

NameRelationship

HomeAddress

City,State,ZIP

HomePhoneCellPhone

WorkPhoneEmployer

ChildCareProvider/School:(Ifapplicable)

Provider/SchoolName:Phone#

MedicalContactInfo:

DoctorName:Phone#

DentistName:Phone#

KnownAllergies:

IauthorizeDavid’sHouse,Inc.anditsrepresentativestocontactanyoftheaboveonmybehalfintheeventofanemergency.

Employee/VolunteerSignatureDate

Name(print):

Employee/Director/ResidentManager/VolunteerProtection(Whistleblower)Policy

Ifanyemployee,director,residentmanagerorvolunteerreasonablybelievesthatsomepolicy,practice,oractivityofDavid’sHouseInc.isinviolationoflaw,awrittencomplaintmustbefiledbythatemployee,director,residentmanagerorvolunteerwiththeExecutiveDirectorortheBoardPresident.Anyinformantmaymakeareportconfidentially,andDavid’sHouseshallexerciseallreasonablemeasurestoprotecttheconfidentialityoftheidentityoftheinformant.Informationwillonlybesharedonaneed-to-knowbasisinordertofollowuponthereport.

ItistheintentofDavid’sHouse,Inc.toadheretoalllawsandregulationsthatapplytotheorganizationandtheunderlyingpurposeofthispolicyistosupporttheorganization’sgoaloflegalcompliance.Thesupportofallemployees,directors,residentmanagersandvolunteersisnecessarytoachievingcompliancewithvariouslawsandregulations.Anemployee,director,residentmanagerorvolunteerisprotectedfromretaliationonlyifthetheybringtheallegedunlawfulactivity,policy,orpracticetotheattentionofDavid’sHouseInc.andprovideDavid’sHouseInc.withareasonableopportunitytoinvestigateandcorrecttheallegedunlawfulactivity.Theprotectiondescribedbelowisonlyavailabletoemployees,directors,residentmanagersandvolunteersthatcomplywiththisrequirement.

David’sHouseInc.willnotretaliateagainstanemployee,director,residentmanagerorvolunteerwhoingoodfaith,hasmadeaprotestorraisedacomplaintagainstsomepracticeofDavid’sHouseInc.orofanotherindividualorentitywithwhomDavid’sHouseInc.hasabusinessrelationship,onthebasisofareasonablebeliefthatthepracticeisinviolationoflaw,oraclearmandateofpublicpolicy.

David’sHouseInc.willnotretaliateagainstemployees,directors,residentmanagersorvolunteerswhodiscloseorthreatentodisclosetoasupervisororapublicbody,anyactivity,policy,orpracticeofDavid’sHouseInc.thattheyreasonablybelieveisinviolationofalaw,orarule,orregulationmandatedpursuanttolaworisinviolationofaclearmandateorpublicpolicyconcerningthehealth,safety,welfare,orprotectionoftheenvironment.

Mysignaturebelowindicatesmyreceiptandunderstandingofthispolicy.IalsoverifythatIhavebeenprovidedwithanopportunitytoaskquestionsaboutthepolicy.

Employee,Director,ResidentManagerorVolunteerSignatureDate