Eastern Pennsylvania and Delaware Division

Volunteer Application

The Salvation Army

Eastern Pennsylvania and Delaware Division

Corps/Unit:______

Volunteers are considered for all work without regard to race, color, sex, national origin, age, marital status, or the presence of a non-job related medical condition or handicap or any other unlawful characteristic.

Please Print PlainlyDate of Application:______

Name______

(Last)(First)(Middle)

Adress______

(Street)(City) (State)(Zip)

Telephone: (_____)______Social Security Number:_____-___-____

How did you find out about us?______

Volunteer activities preferred: ______

Location preferred:______

Are you available to volunteer: ______Full time ______Part time ______As needed

HOURS AVAILABLE TO VOLUNTEER (Please check appropriate boxes)

MON / TUE / WED / THU / FRI / SAT / SUN
DAY HOURS
EVENING HOURS

Are you known by another name? (To former employers, school or friends) _____Yes ____NO

If Yes, please provide name:______

In Case of emergency, notify (name & phone number):______

Have you been employed by or volunteered at a Salvation Army program or service provider in the past?

____No. _____Yes. If yes, give date(s) and the name of The Salvation Army program/service provider location. ______

EDUCATION and TRAINING

Training / High School / College/University / Graduate/Professional
School Name & Address
Highest Grade Completed (Please Circle) / 9 10 11 12 / 13 14 15 16 / 1 2 3 4
Diploma/Degree/Course of study
Specialized Skills/Training

EMPLOYMENT EXPERIENCE:______

______

REFERENCES

Provide two names, address and telephone numbers for personal references who are not related to you and are not current or previous employers.

______

APPLICANT STATEMENT AND AUTHORIZATION

I certify that all information I have provided in order to do volunteer work with The Salvation Army is true, complete and correct.

I understand that any information provided by me that are found to be false, incomplete or a misrepresentation in any respect, will be sufficient cause to either cancel further volunteer work, whenever it is discovered.

I expressly authorize, without reservation, The Salvation Army, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I release all parties from liability for any damage that may result from furnishing information, and I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

______

Signature Date

CONFIDENTIAL

THE SALVATION ARMY

STATEMENT OF VOLUNTEERS

(Salvationists And Non-Salvationists) For Work with Children*

This statement will be completed by all applicants for employment for any position involving the supervision or custody of children (under 18 years of age) or for any position in which the applicant is in any way involved with children. The completion of the statement will help to assure The Salvation Army that it will provide a safe and secure environment to those children who participate in its programs and who use its facilities.

Personal Information

Personal Information

Name______

LastFirstMiddle

Present Address______

Number Street City State Zip

Home Phone (______)______

Social Security Number:______

Present Church:______

Minister of the Church:______

Other Churches attended regularly during the past ten years:______

______

______

Education or training for work with children (list formal education courses and on the job training participated in. identifying the institution.)______

______

______

Personal References (Not relatives)

Name:______Name______

Address:______Address:______

Telephone Number______Telephone Number:______

All prior work with children (List the church or other organization conducting the program, the name of the immediate supervisory and, if known, the name, address, and telephone number of any individual now involved in the program)

______

______

* For purposes of this Statement, the words “child” and “children” mean persons below the age of 18 years.

STATEMENT OF APPLICANT FOR VOLUNTEERING INVOLVING WORK WITH CHILDREN PAGE 2

Statement

As the applicant described above, I do hereby represent to The Salvation Army, with the understanding that The Salvation Army will rely upon the information provided in considering my application for work with children, that the foregoing information and following statements are true:

In my prior Volunteer, I have never used a name other than that set forth above.

I understand the essential duties of my position in connection with the working with children in the programs of The Salvation Army. I am able to perform those essential job duties with no accommodation except as follows: ______

I have never been accused of abuse of a child or of actual or attempted sexual molestation of a child, either in a program for children or otherwise. If the foregoing statement is not true, please describe the circumstances of the accusation and the outcome:

______

I have never been arrested as a result of a charge of child abuse or of actual or attempted sexual molestation of a child.

I have never been convicted of child abuse or a crime involving actual or attempted sexual molestation.

I authorize any of the churches and their representatives and my personal references listed above to give The Salvation Army any information they may have regarding my character and fitness for work with children. I release all such organizations and individuals from any liability that may result from their furnishing such information to The Salvation Army. I waive any right that I may have to inspect any records containing such information.

I am aware that The Salvation Army is a branch of the Christian Church and, in the event that my application is accepted, I agree that I will conduct myself in my work with children in a way that is consistent with the religious and charitable policies and principles of The Salvation Army.

Having provided the foregoing information and have affirmed the foregoing statements are true I recognize that any false information or statements are punishable under the laws relating to perjury.

______

Signature of Applicant

Date:______20______

______

Signature of Witness

Name______

Address:______

City State Zip

THE SALVATION ARMY

Lehigh Valley

Media Release Form

Ihereby grant to The Salvation Army and those acting under its authority, to record on film, tape or otherwise my name, likeness, voice, performance and actions. I acknowledge that my performance may be edited as desired by The Salvation Army and may be used in perpetuity and authorize others to use, such recording as The Salvation Army sees fit throughout the U.S., Canada and abroad on television and radio broadcasts and rebroadcasts, in theatrical and non-theatrical exhibition, audio-visual/school/home use, in any production, in any and all media now known or hereafter devised throughout the world, and to use, license, market, and distribute in any medium or forum said productions and any other productions in which said recording may be incorporated.

I waive the right to inspect or approve any such use of my name, likeness, voice or actions, and hereby also authorize The Salvation Army and those acting under its authority to use my name, likeness, voice, actions, biography, and/or composition for purposes of promotion and publicity in connection with the program material.

Further, I hereby waive and forego any compensation for my appearance in the production. I release The Salvation Army, their officers, agents, employees and those acting under their authority from all claims and liabilities of any kind arising out of or in connection with the making or uses of such films or recordings.

The rights granted herein shall insure to the benefit of The Salvation Army, its licensees, successors and assigns.

______

Name (print)Signature Date

______

Address

______

CityStateZip

______

Phone

Volunteer Expectations

It is the expectation of The Salvation Army that ALL persons scheduled to work at this agency conduct themselves in a professional manner. This includes speech and dress. Shoes covering the entire foot must be worn. Shirts should not be revealing or tight fitting and should not include any offensive content or slogans.

Work assignments and instructions as it relates to duties will come from an immediate supervisor, or other staff designate.

It is expected that all tasks assigned will be completed when assigned.

All volunteers will be scheduled with the Volunteer Coordinator or appropriate department head before being assigned work hours. Coordinator and/or department head is responsible to see that all appropriate documentation has been completed and train volunteers how to sign in and out properly.

Please return your application to the nearest Salvation Army that you would like to volunteer in:

The Salvation Army Allentown The Salvation Army Bethlehem

C/O Volunteer Coordinator C/O Volunteer Coordinator

P.O. Box 147 P.O. Box 348

Allentown, Pa 18105 -0147 Bethlehem, Pa 18016

t. 610.432.0129 t. 610.867.4681

The Salvation Army EastonThe Salvation Army Pen Argyl

C/O Volunteer CoordinatorC/O Volunteer Coordinator

P.O. Box 937P.O. Box 57

Easton, Pa 18044Pen Argyl, Pa 18072

t. 610.258.9531t. 610.863.6677

1