Volunteer Application Packet
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- Stephany Tyler
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1 Volunteer Application Packet 6560 Poplar Avenue, Suite B Memphis, TN P: (901) F: (901) Please fill out pages 5-8 completely and return. Please include a copy of your driver s license and a copy of your auto insurance card. Revised 12/23/2015
2 Welcome to JFS at MJCC! Thank you for your interest in volunteering for Jewish Family Service at MJCC. We pride ourselves on being here for our clients when they can t do it alone. Well, JFS can t do it alone either. We count on and depend upon our large cadre of volunteers. Without them, we wouldn t be able help the community the way we do by engaging isolated seniors, holding the hands of the terminally ill, visiting the sick, leading religious services, and helping the special needs community. Enclosed is a summary of volunteer positions and an application. All volunteers working with clients must agree to a background check and drug screen, which are mandated by our funders. We realize the process can be time-consuming and we appreciate your patience. Please fill out all pages and return the attached application to Janet Rubin, LMSW. Again, we are very appreciative of your interest in supporting JFS at MJCC as it fulfills its mission. Janet Watson, LCSW Director of Social Services Phone (901) Fax (901) jwatson@jccmemphis.org 6560 Poplar Avenue Memphis, TN Janet Rubin, LMSW Coordinator of Volunteer Services Phone (901) Fax (901) jrubin@jccmemphis.org 6560 Poplar Avenue Memphis, TN Page 2
3 Volunteer Opportunities Jewish Family Service at Memphis Jewish Community Center is able to provide services to those in need in part because of the help we receive from volunteers. Everyone has something to contribute. Our philosophy is that volunteers are an integral part of our agency and staff, and we will make every effort to make this a positive experience that meets your goals and expectations. Making a Difference You can make a difference and become part of a rewarding experience through the JFS at MJCC Volunteer Services Program. Volunteers perform an important role in fulfilling the agency s mission of service to the community. It is never too late to make a difference in someone s life. Friendly Visitors These special friends provide companionship and socialization opportunities to individuals in need. Volunteers meet a few times a month with older adults in their homes, and participate in activities ranging from playing board games, to sitting and chatting, to taking walks or going on short outings. All volunteers are carefully screened, matched, interviewed and trained before working with older adult clients. Handy Helpers/Chore This service provides assistance to seniors in order to ensure that they remain safe and secure in their homes. Volunteers will be called on an as-needed basis. Volunteers who agree to Handy Helpers or Chore services will provide duties such as changing light bulbs, hanging objects, and aiding in minor repairs. Driving a senior to the grocery store and helping them with their shopping is also an important part of this service. Stay In Touch The Stay In Touch program matches homebound seniors with community volunteers who will regularly contact senior adults via telephone to check on their safety and well-being. In addition, the telephone assurance program can be mobilized in cases of emergency, like a natural disaster, to check in on our senior adults. Page 3
4 Meals on Wheels JFS at MJCC s Home Delivered Meal program provides home-bound seniors and disabled adults with frozen, appetizing and nutritious kosher meals. Our goal is to promote health and wellness, while supporting the individuals desire to remain independent in familiar surroundings. Volunteers who agree to assist in the Meals on Wheels program will aid in duties such as sorting, packaging, serving and/or distributing of meals. Administrative and Agency Support JFS at MJCC has many on-going projects at our office. Volunteers assist with or lead one of these projects or simply help with administrative tasks around the office. There are always projects that need your energy, and you may submit your name and contact information as an on-call office volunteer or contact us regarding a specific skill you have to share with JFS at MJCC. Professional Services Individuals with professional experience in the areas of development, medical, legal, social work and finance are also needed. You can choose to work on specific projects, serve on one of our committees, and/or provide professional pro bono services. Shabbat Shalom Visitors JFS will provide religious services to residents at area senior living facilities. This outreach allows these Jewish residents to maintain their spiritual connection while celebrating Shabbat, and other Jewish holidays. Volunteers will be given materials to lead a service, tell a story or lead a sing along for the holiday. Special Needs We provide information, counseling, social programming, advocacy and comprehensive support for children and adults with special needs, as well as their families and caregivers. Volunteers in this area would be asked to drive and chaperone adults with special needs at various events and classes. Volunteers may also be a buddy to someone with special needs and provide respite care. Page 4
5 Volunteer Application Form 6560 Poplar Ave. Memphis, TN P: (901) F: (901) Name Mr. Mrs. Ms. Miss Dr. Street address Date of Birth (MM/DD/YY) City State Zip Primary phone H W C OK to leave message? OK to text? Alternate phone H W C OK to leave message? OK to text address Why do you want to volunteer? What would you like to gain from volunteering? Do you have previous volunteer experience? Yes No List when, where, and describe your volunteer responsibilities: Do you know any foreign languages? Yes No If so, which one(s)? Written? Spoken? Please list any special skills, interests, and hobbies In which area(s) are you most interested in volunteering? Administrative Friendly Visitor Handy Helpers/Chore Service Shabbat Shalom Visitors Professional Services Meals on Wheels Stay In Touch I am willing to drive a client in my car: Page 5 Special Needs Yes No
6 Office Use Only Date Received Orientation Date Program Assignment Staff Person Name Driver s license number State Exp. Date Vehicle insurance company Policy # Please indicate which days and times you are able to volunteer: Mon. Tues. Wed. Thurs. Fri. Sat. Sun. Anytime From: To: How many hours are you available to volunteer? Weekly Monthly How often? Daily Weekly Monthly Are you willing to commit at least 6 months to your assignment? Yes No Please provide the name, address and phone numbers of two references NOT related to you: Name Address City St. Zip Phone Name Address City St. Zip Phone In case of emergency, please notify: Name Phone Security, safety, and confidentiality for our clients are essential in a volunteer or any other program. Therefore, we must run a background check, motor vehicle report, and reference check. Have you ever been convicted of a felony? Yes No Have you ever pled guilty, been convicted of, or received probation for a criminal offense within the last seven (7) years? Yes No If yes, please provide details: Have you ever been on a child predator registry? Yes No Have you pled guilty, been convicted of, or received probation for a violation of driving while intoxicated or possession of a dangerous controlled substance? Yes No If yes, please provide details: Page 6
7 AUTHORIZATION TO OBTAIN A MOTOR VEHICLE REPORT I hereby authorize Jewish Family Service at Memphis Jewish Community Center to obtain a Motor Vehicle Report on my driving history. I consent without any undue influence or duress. Signature Date Name (please print) Please Read Carefully and Thoroughly Before Signing By signing below, I certify that the information provided on this application is true and complete to the best of my knowledge. I understand that any misstatement, falsified information, significant omission or representation provided by me will make me ineligible for selection/retention as a volunteer for the Jewish Family Service, a department of the Memphis Jewish Community Center. I authorize MJCC to investigate all statements and information contained in this application, to make inquiries as may be necessary in arriving at a decision and to obtain a criminal background check as well as a Tennessee Motor Vehicle Report. I further understand as a MJCC volunteer, I must (1) maintain full client confidentiality; (2) fulfill the responsibilities and comply with guidelines of the volunteer position as specified in the service description; (3) attend all orientation and training sessions and (4) maintain ongoing contact with the Volunteer Coordinator or other JFS at MJCC staff. I certify that I have read, fully understand, and accept all terms of the foregoing application. I understand that this application is not a guarantee of placement. Signature Date Print name Page 7
8 CERTIFICATION AND AUTHORIZATION I have been asked by the Memphis Jewish Community Center ( MJCC ) to furnish information for use in reviewing my background and qualifications for volunteer work. The MJCC may obtain information contained in employment records, educational records, military records, court records, driving records, and criminal records. I understand that this investigation may include interviews with references or others. I understand that my volunteer work or continued volunteering is contingent upon the successful completion of this background investigation. AUTHORIZATION I hereby authorize the MJCC, or any of its agents, to conduct an investigation of my background and qualifications. I authorize the release of any information pertaining to my background and qualifications, including those categories of information listed above, whether the information is of public record or not. This authorization shall remain effective for any future investigations by the MJCC. I authorize any reference, school, former employer or other person to disclose to the Memphis Jewish Community Center, upon request, any information they may have about me and I release them from any and all liability for disclosing such information to the Memphis Jewish Community Center. I release the Memphis Jewish Community Center and its employees plus other persons or companies retained by the Memphis Jewish Community Center from any and all liability arising out of or related in any way to gathering any information in connection with my volunteer work. CONSENT TO DRUG SCREENING As a volunteer of the Memphis Jewish Community Center I hereby acknowledge being informed of the Memphis Jewish Community Center s intention to screen volunteers to determine substance abuse as part of their Drug Free Workplace process. In consideration of my continued volunteer work with the Memphis Jewish Community Center, I consent to being screened for the presence of drugs and agree to provide voluntarily, such specimens as may be requested by the medical facilities acting on the Memphis Jewish Community Center s behalf. I further agree to sign an additional consent form required by the entity that performs the drug screen to release the results to the Memphis Jewish Community Center. I understand that the results of such drug screen will be communicated only to employees of the Memphis Jewish Community Center who are involved in the Drug Free Workplace process, as well as to any employee and/or agent deemed necessary. I hereby consent to the release of said result to the foregoing persons. I understand that, if the result of the drug screen is positive, I will be informed of, and provided a copy of said results. I understand that my volunteer work with the Memphis Jewish Community Center is conditioned on a negative result from the drug screen. Signature Date Print Name SSN # Date of Birth Current Address Zip Code Parent Signature (If under 18) Print Name Please list additional addresses occupied in the past 7 years and the number of years at each address: Number of Years Address Street Address City, State, Zip Code Number of Years Address Street Address City, State, Zip Code Number of Years Address Street Address City, State, Zip Code Page 8
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