Volunteer Application - Senior Services For The South Sound

Volunteer Application

Thank you for your interest in volunteering with Senior Services for South Sound! Our programs would not be possible without many people generously donating their time, skills, and energy to further our mission. Please fill out the following information so that we can help you have the best possible volunteer experience. Be sure to click "Submit" when finished so that we receive your application!
Please provide your first name.
Please provide your middle name.
Please provide your last name.
Please provide your date of birth.
Please provide your street address.
Please provide your city.
Please provide your state.
Please provide your Zip Code
Please provide your preferred phone number.
Please provide your preferred e-mail address.
Please provide emergency contact information.
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In order to ensure the safety of our clients, other volunteers, and staff, and to protect Senior Services for South Sound from risk of liability, you must agree to the following: Criminal History Background Check By your signature, you authorize Senior Services for South Sound to conduct a thorough Criminal History Background Check at the time your Volunteer Application is received, and every two (2) years thereafter, or as deemed necessary. The Criminal History Background Check draws upon records from multiple sources including,but not limited to, Washington Access To Criminal History (WATCH) and the National Sex Offender Registry (NSOR). An adverse background check finding does not automatically disqualify you from volunteering. Disqualifying offenses are as listed in WAC 388-113-0020.
Nondisclosure of Confidential Information Definitions “Confidential Information” means information that is exempt from disclosure to the public or other unauthorized persons under Chapter 42.56 RCW or other federal or state laws. Confidential Information includes, but is not limited to, protected health information as defined by the federal rules adopted to implement the Health Insurance Portability and Accountability Act of 1996, 42 USC §1320d (HIPAA), and Personal Information. “Personal Information” means information identifiable to any person, including, but not limited to, information that relates to a person’s name, health, finances, education, business, use or receipt of governmental services or other activities, addresses, telephone numbers, social security numbers, driver license numbers, other identifying numbers, and any financial identifiers. Why Volunteers? Because in volunteering for Senior Services for South Sound (“Senior Services”), you will have information about and may hear about health conditions. Because you play an important part in clients’ lives and have access to private information about their children and families. There are penalties for organizations that do not follow the law. This means that Senior Services, and you, as part of the organization, must act under these guidelines to protect our clients and the good name of Senior Services. How Volunteers can Protect Clients’ Privacy & Rights Because Senior Services is all about serving clients, we need to protect their private information as if it was our own. We can do this every day by being aware of our practices. By signing below, I agree that I: 1. Will not use, publish, transfer, sell or otherwise disclose any Confidential Information gained by being a volunteer for any purpose that is not directly connected with the performance of my duties except as allowed by law. 2. Will protect and maintain all Confidential Information gained by being a volunteer against unauthorized use, access, disclosure, modification or loss. 3. Will employ reasonable security measures, includingrestricting access to Confidential Information by physically securing any computers, documents, or other media containing Confidential Information. 4. Will access, use, and/or disclose only the“minimum necessary” Confidential Information required to perform my assigned job duties. 5. Will not share computer system passwords with anyone or allow others to use the systems logged in as me. 6. Will not distribute, transfer, or otherwise share any Senior Services software with anyone. 7. Understand the penalties and sanctions associated with unauthorized access or disclosure of Confidential Information. 8. Will forward all requests I may receive to disclose Confidential Information to my supervisor for resolution. 9. Understand that my assurance of confidentiality and these requirements do not cease when I am no longer a volunteer.
Mandatory Reporting If you suspect a vulnerable adult living in their own home or apartment or living in an adult family home, boarding home, or nursing home is being abused, neglected, or exploited, DSHS Adult Protective Services must be called at 1.877.734.6277.
Code of Conduct 1. Treat all participants, volunteers, and staff with respect and empathy. 2. Treat equipment with respect by proper use and care. 3. Respect the rules of access to space and/or equipment. 4. Respect the confidentiality of clients and participants in programs of Senior Services. 5. Use appropriate language; no foul language, innuendoes, or gestures will be tolerated. 6. Be responsible for yourself and your personal belongings. 7. Be understanding of others’ feelings. Abstain from arguing, violent behavior, or threats. 8. If there is a situation, please get your supervisor or other paid staff person to intervene.
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Please provide your signature to agree to the conditions above.
If you have any questions about this application, please e-mail us at volunteer@southsoundseniors.org, or call us at 360.586.6181 x108. Thank you again for your interest in volunteering with Senior Services for South Sound!

Olympia Senior Center
222 Columbia Street NW
Olympia, Washington 98501
Hours: 8:30 am - 4:00 pm
360.586.6181
admintemp@southsoundseniors.org

Lacey Senior Center
6757 Pacific Avenue SE
Lacey, Washington 98503
Hours: 8:00 am - 4:00 pm
360.407.3967
laceysc@southsoundseniors.org

Mason County Office
By Appointment Only
360.525.3238

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