H.E.R. Shelter Volunteer Application
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Trinidad and Tobago
Bosnia and Herzegovina
United Arab Emirates
Papua New Guinea
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Sao Tome and Principe
United Republic of Tanzania
Country / Region
Work or Cell Phone
Please list School(s) attended, Field of Study, Degree.
Please list your employer, job title, description of work, and dates employed.
List any relevant experience or training related to crisis intervention, domestic violence and/or working with children.
Why do you want to volunteer at the H.E.R. Shelter?
How did you hear about the H.E.R. Shelter?
By checking the box below, you are confirming that the information provided in this application is true and that any statement may be verified without causing liability to Help and Emergency Response, Inc.
Criminal Background Check Authorization
All volunteers are required to submit a criminal background check. I understand that in applying to volunteer, I am also authorizing Help and Emergency Response to conduct background check for volunteer purposes.
Falsifying any information in this document will result in the revocation of any privileges in volunteering at Help and Emergency Response, Inc.
I authorize H.E.R. to conduct background check.
Help and Emergency Response Inc., Confidentiality Agreement
I understand that communications, documents and other client information in which I have access to, and learn of, during my internship or as a volunteer at Help and Emergency Response, Inc., are confidential and highly privileged. Therefore, I agree to uphold the terms, conditions and obligations set forth in the Confidentiality Policy of the H.E.R. Shelter. I understand and agree that I am obligated to maintain confidentiality of all and abide by all rules, procedures, directives and policies of H.E.R. Shelter. I will protect client information by preserving and maintaining the confidentiality of client.
I further agree:
1. My relationship and interactions with clients will be professional.
2. Under no circumstances will I discuss client information with anyone, unless the
disclosure is required in the performance of my duties and responsibilities of H.E.R.
Shelter. Moreover, any disclosure of any client information shall be in conformance with the terms and conditions of the H.E.R. Shelter’s Confidentiality Policy.
3. I will not disclose to clients any of the business conducted in H.E.R. Shelter and its
programs, including but not limited to business conducted and discussed at staff
4. I will not discuss client information of one client with another.
5. I will not confirm or deny the presence of any client in the Domestic Violence Programs,
battered women’s shelters or Response Sexual Assault and Awareness Program or the
provision of services to any client without the client’s written permission.
6. I will not disclose the location of the DVP Battered Women’s Shelter, except to persons who may need to know the location in an emergency. I will advise my supervisor of all individuals to whom I have disclosed the location of the shelter.
7. I will contact Child Protective Services (CPS) when I suspect or have knowledge or
reason to believe that a child has been abused and/or neglected.
8. I will report any allegations of abuse of older or incapacitated adults to Adult Protective Services.
By checking the box below, I confirm that I have read the Confidentiality Policy & Agreement and understand the terms, conditions and obligations imposed by them, and I agree to the above conditions.
Volunteer Standards of Conduct
All H.E.R. Shelter volunteers are expected to maintain appropriate Standards of Conduct that are pertinent to Help and Emergency Response, Inc.
Timely and Regular Attendance Performance
1. Volunteers will sign their first and last names in the Volunteer Book located in the hotline room.
2. Any schedule changes please notify the Volunteer Coordinator at least two days prior or as soon as possible.
3. Each volunteer has agreed to serve a minimum of six months at H.E.R. Shelter (written on the Volunteer Agreement).
*Violation of these terms or agreements without following the proper procedures may result in termination.
1. Volunteers are expected to meet specific program requirements. Any conditions or circumstances that will prevent volunteers from completing their assigned tasks should be reported immediately.
2. Evaluations will be completed after 3 months of service.
THE FOLLOWING WILL NOT BE TOLERATED AND WILL BE GROUNDS FOR
IMMEDIATE DISMISSAL FROM H.E.R. SHELTER AND THE VOLUNTEER PROGRAM:
1. Any violent behavior, including spanking and swearing; this also includes abusive behavior towards staff, other volunteers, or residents (verbal or physical).
2. Weapons on shelter property.
4. Tampering with shelter security system, including door or window sensors.
5. Disclosing location of the shelter.
6. Divulging confidential information.
7. Alcohol or any illegal drug use.
8. Sexual activity in the shelter.
9. Leaving children unsupervised.
Not complying with H.E.R. Shelter Policies and Procedures Violations of the Standards of Conduct which, seriously undermines the effectiveness of H.E.R. Shelter activities and/or would discredit or injure the public service, will either be re-assigned or terminated at the discretion of the organization.
By checking the box below, you are confirming that you have read the Volunteer Standards of Conduct and will comply with the regulations.
Volunteer Grievance Form
Any volunteer who believes that he/she is the subject of unfair treatment, practices or disciplinary action (verbal warning or written violation) has the right to grieve said incident.
1. If a H.E.R. Shelter volunteer has a grievance regarding the volunteer program or staff, these concerns should be made directly to the Volunteer Coordinator. The Volunteer Coordinator will be responsible for responding to the grievance in a timely manner.
2. If the volunteer feels unsatisfied with the outcome, a written inquiry must be made to the Program Director of H.E.R. Shelter.
3. If, after pursuing this course of action, the volunteer is still not satisfied with the results, the Program Director may consult with the Executive Director for resolution.
4. Following such consultation between the Program Director and the Executive Director, the volunteer will be notified of the final resolution.
5. In the case of an emergency situation (i.e. the immediate dismissal of volunteer against Volunteer Policies and Procedures), the staff person(s) on duty may, in good faith, follow through with the disciplinary action, providing the appropriate personnel have been notified.
By checking the box below, you are confirming that you have read the Volunteer Grievance Form and will comply with the regulations.
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