The Salvation Army – Del Oro Division
2019 Volunteer Process STEP I Below is the list of documents needed for a COMPLETE Volunteer File: • •
Option 1: The volunteer completes the application on a computer. When the Data Page is filled in the subsequent pages will populate the pages below. OR Option 2: Print the entire blank packet and allow the volunteer write-in all the information. Please note: The Social Security Number is needed to run the background check. All volunteers must have a background check completed.
Print the following documents for the volunteer to review and sign. (Electronic signatures are not acceptable) 1. The Application – interviewer’s signatures also required. 2. The Sterling Consent Form – volunteer signature on page 2 & 3, Give pages 4 &5 to the volunteer. 3. The California Child Abuse Reporting Law 4. Code of Ethics for Working with Minors and Vulnerable Adults 5. Statement of Volunteers – Work with Children- complete pages 1 & 2. • If the volunteer will be driving TSA vehicle in any capacity, an MVR (Motor Vehicle Report) must be submitted via Sterling, AND the Volunteer must complete the Driver Qualification File (DQF). Send STEP 1 files to: DO.volunteerbackground@usw.salvationarmy.org • Remember to name the file as follows: V1 LastName, FirstName Volunteer Location o Example: V1 Jones, Eugene Volunteer DHQ
Check-off List Step 1
You will receive an email noting that the volunteer’s background is CLEAR.
Submit the following documents After the background check is CLEARED
• The hiring location completes page 3 of Statement of Volunteers Form. Print the following documents for the volunteer to review and sign. (Electronic signatures are not acceptable) 6. Volunteer Agreement for long term positions of great responsibilities. 7. The Social Media Policy 8. The Volunteer Release and Waiver of Liability Form 9. Complete the DQF (Driver Qualification File) Packet. (if necessary) Send the STEP 2 files and DQF Packet to: DO.volunteerbackground@usw.salvationarmy.org • Label the file as follows: V2 LastName, FirstName Volunteer Location • Example: V2 Jones, Eugene Volunteer DHQ Additional local files should remain in the Corps/Units volunteer file.
Consent Form (p. 1,2,&3) CA Child Abuse Reporting Law Code of Ethics for Working with Minors and Vulnerable Adults Statement of Vol Work with Children an Vulnerable Adults (pages 1 & 2)
Step 2
STOP STEP 2
Application
Statement of Volunteers with Children and Vulnerable Adults page 3 completed Volunteer Agreement for long term positions of great responsibilities. The Social Media Policy The Volunteer Release and Waiver of Liability Form Complete the DQF (Driver Qualification File) Packet. (if necessary)
Volunteer Data Page Complete the information below to populate the forms in the Volunteer Packet or Print the the forms to allow the Volunteer to complete the forms. Corps/Unit Corps/Unit Complete Address First Name Middle Name or Initial Last Name Full Name Address City State Zip Code Phone- 000 000-0000 SSN - For Background Checks Email (Optional)
TSA Representative or Witness
Yes Yes
Driver - TSA Passenger Cars Driver - Larger vehicle (DOT)
No No
If the volunteer will be driving a TSA a Motor Vehicle Report (MVR) must be completed. Check the box below add the MVR to this packet.
Yes
The Salvation Army – Del Oro Division
Volunteer Application Corps/Unit: ______________________ City: _____________________ Volunteer’s Name: _________________, _________________ ____________________ Date:____________ Last
First
Middle
Address: __________________________________________ State: _____ Zip Code: _______________ Home Phone: ________________________________________
Best time: ___________________________
Emergency Contact: __________________________________
Phone: _____________________________
I will assist wherever the need is greatest I need ________ hour(s) to fulfill my community hours commitment for:
(agency/organization) AVAILABLITY: Day Start End
Sun
Mon
Tue
Wed
Thu
Fri
Sat
I would like to volunteer in the following area(s):
I am interested in the following activities: Rank level of interest from 1 (great interest) to 3 (some interest) Holiday programs
Landscaping, yard work
Shelter Work
Transportation
Bell ringing
General office, clerical
Clothing, food drives, donation processing
One-time events
Disaster Relief (Complete disaster supplement)
Children’s art projects such as making banners, gifts
Working with children, tutoring, child care, mentoring
Music or other performance
Domestic violence advocacy
Pantry Worker
Carpentry, plumbing, maintenance
Other: Please specify
I have or would like to gain experience in the following areas: Indicate years’ experience or Write “L” if you would like to learn a new skill. Project development and implementation
Graphic design
Writing, speaking, community relations
Musical performance: Please specify
Fundraising, Asking for donations
Computer: Please specify
Tutoring, teaching, early childhood development
Event planning
Counseling, facilitating support groups
Driving a truck or 12 passenger van
Construction or building trades: Please specify
Foreign language interpretation: Specify language(s)
Clerical work Legal advocacy
Del Oro Volunteer Application 02/25/19
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EXPERIENCE / ABILITIES – (Select all that apply)
Typing (words per minute)=
Good printing
Run copiers
Good phone personality
Computer experience
Medical Expertise
Filing
Car available for deliveries/pick-ups
Good handwriting
Class B license (w/ passenger endorsement)
I also have the following abilities that could be useful: ______________________________________________
PREVIOUS WORK EXPERIENCE – attach a resume if available Employers’ Name City and State
Job Title
Years of work
Field of Study
Diploma/ Degree
ups
EDUCATION School
City and State
REFERENCES Anyone volunteering for Salvation Army programs must have a reference check. Please include at least one reference (personal or business) that we may contact: Name
Phone
Relationship
1 2 Please note: A Motor Vehicle Report (driving record) must be submitted through Sterling for all persons driving TSA vehicles. The volunteer must also complete the DQF packet and complete the TSA drivers training module. Will this volunteer drive TSA vehicles?
Yes
No
Volunteer has: Commercial Driver’s License
Yes
No
Describe the type of vehicle:
Van
Bus
or Class B with passenger endorsement
15 Under passengers
16+ passengers
Yes
No
Box Truck
Canteen
VOLUNTEER STATEMENT I understand that The Salvation Army, a religious and charitable organization, utilizes volunteers in the conduct of its various spiritual and social programs. It is my desire to further the work of The Salvation Army by performing services as a volunteer for the Salvation Army and its programs. I do not expect to receive wages or any other type of compensation for my work. I acknowledge that I am not acting as an employee of The Salvation Army. As a “volunteer” I realize that I have no legal claims for minimum wages, overtime, premium, unemployment compensation, workers’ compensation, or other provisions of law for “employees”. Rather it is my desire to help The Salvation Army accomplish its mission. Date:___________________
Volunteer Signature: ________________________________________
Date:___________________
Interviewer Signature: _______________________________________
Del Oro Volunteer Application 02/25/19
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Location: PRINT CHARACTERS LIKE THIS
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_______ ________ Applicant's First Name or Initial
Last Name
Consent to Request Consumer Report & Investigative Consumer Report Information I understand that THE SALVATION ARMY, a California Corporation, (‘COMPANY’) will use Sterling Info Systems Inc., 249 West 17th Street, New York, NY 10011, (877) 424-2457 to obtain a consumer report and/or investigative consumer report (“Report”) as part of the hiring process. I also understand that if hired, to the extent permitted by law, COMPANY may obtain further Reports from STERLING so as to update, renew or extend my employment. I understand Sterling Info Systems Inc.’s (“STERLING”) investigation may include obtaining information regarding my credit background, bankruptcies, lawsuits, judgments, paid tax liens, unlawful detainer actions, failure to pay spousal or child support, accounts placed for collection, character, general reputation, personal characteristics and standard of living, driving record and criminal record, subject to any limitations imposed by applicable federal and state law. I understand such information may be obtained through direct or indirect contact with former employers, schools, financial institutions, landlords and public agencies or other persons who may have such knowledge. If an investigative consumer report is being requested, I understand such information may be obtained through any means, including but not limited to personal interviews with my acquaintances and/or associates or with others whom I am acquainted. The nature and scope of the investigation sought is indicated by the selected services below: (Employer Use Only)
Criminal Background Check SSN Trace Motor Vehicle Report Consumer Credit Report Other Please List:
Education Verification Employment Verification Personal Reference Professional License/Certification
Sex Offender Search OFAC/Terrorist Watch List Fraud & Abuse Control Info System (FACIS®) Office of Inspector General Sanctions (OIG)
I acknowledge receipt of the attached summary of my rights under the Fair Credit Reporting Act and, as required by law, any related state summary of rights (collectively “Summaries of Rights”). This consent will not affect my ability to question or dispute the accuracy of any information contained in a Report. I understand if COMPANY makes a conditional decision to disqualify me based all or in part on my Report, I will be provided with a copy of the Report and another copy of the Summaries of Rights, and if I disagree with the accuracy of the purported disqualifying information in the Report, I must notify COMPANY within five business days of my receipt of the Report that I am challenging the accuracy of such information with STERLING. I hereby consent to this investigation and authorize COMPANY to procure a Report on my background. In order to verify my identity for the purposes of Report preparation, I am voluntarily releasing my date of birth, social security number and the other information and fully understand that all employment decisions are based on legitimate non-discriminatory reasons. The name, address and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries regarding the investigative consumer report is: Sterling Infosystems, Inc. | 249 W 17th St. 6th Floor, New York, NY 10011 | 877-424-2457 | or | 5750 West Oaks Boulevard, Ste. 100 Rocklin, CA 95765 | 800-943-2589 |
California, Maine, Massachusetts, Minnesota, New Jersey& Oklahoma Applicants Only: I have the right to request a copy of any Report obtained by COMPANY from STERLING by checking the box. (Check only if you wish to receive a copy)
California, Connecticut, Maryland, Oregon, Vermont and Washington State Applicants Only (AS APPLICABLE): I further
understand that COMPANY will not obtain information about my credit history, credit worthiness, credit standing, or credit capacity unless: (i) the information is required by law; (ii) I am seeking employment with a financial institution (California, Connecticut and Vermont only – in California the financial institution must be subject to Sections 6801-6809 of the U.S. Code and in Vermont it must be a financial institution as defined in 8 V.S.A.§ 11101(32) or a credit union as defined in 8 V.S.A. § 30101(5)); (iii) I am seeking employment with a financial institution that accepts deposits that are insured by a federal agency, or an affiliate or subsidiary of the financial institution or a credit union share guaranty corporation that is approved by the Maryland Commissioner of Financial Regulation or an entity or an affiliate of the entity that is registered as an investment advisor with the United States Securities and Exchange Commission (Maryland only); (iv) I am seeking employment in a position which involves access to confidential financial information (Vermont only);(v) I am seeking employment in a position which requires a financial fiduciary responsibility to the employer or a client of the employer, including the authority to issue payments, collect debts, transfer money, or enter into contracts (Vermont only); (vi) COMPANY can demonstrate that the information is a valid and reliable predictor of employee performance in the specific position being sought or held; (vii) I am seeking employment in a position that involves access to an employer’s payroll information (Vermont only);(viii) the information is substantially job related, and the bona fide reasons for using the information are disclosed to me in writing, (complete the question below)(Connecticut, Maryland, Oregon and Washington only);(ix) I am seeking employment as a covered law enforcement officer, emergency medical personnel, firefighter police officer, peace officer or other law enforcement position (California, Oregon and Vermont only - in Oregon the police or peace officer position must be sought with a federally insured bank or credit union and in Vermont the law enforcement officer position must be as defined in 20 V.S.A. § www.sterlinginfosystems.com Page 1 of 5 249 West 17th Street, 6th Floor, New York, NY 10011 Telephone 877-424-2457 Facsimile 646-536-5239 09/2012
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Applicant's First Name or Initial
CORRECT
INCORRECT
Last Name
2358, the emergency medical personnel must be as defined in 24 V.S.A. § 2651(6), and the firefighter position must be as defined in 20 V.S.A. § 3151(3)); (x) the COMPANY reasonably believes I have engaged in specific activity that constitutes a violation of law related to my employment (Connecticut only); (xi) I am seeking a position with the state Department of Justice (California only); (xii) I am seeking a position as an exempt managerial employee (California only);and/or (xiii)) I am seeking employment in a position (other than regular solicitation of credit card applications at a retail establishment) that involves regular access to all of the following personal information of any one person: bank or credit card account information, social security number, and date of birth,, I am seeking employment in a position that requires me to be a named signatory on the employer’s bank or credit card or otherwise authorized to enter into financial contracts on behalf of the employer, I am seeking employment in a position that involves access to confidential or proprietary information of the Company or regular access to $10,000 or more in cash (California only). Bona fide reasons why COMPANY considers credit information substantially job related (complete if this is the sole basis for obtaining credit information) or in California and Vermont the COMPANY’S basis for the credit check.
___________________________________________________________________________________________________________ NY Applicants Only: I also acknowledge that I have received the attached copy of Article 23A of New York’s Correction Law. I further understand that I may request a copy of any investigative consumer report by contacting STERLING. I further understand that I will be advised if any further checks are requested and provided the name and address of the consumer reporting agency. California Applicants and Residents: If I am applying for employment in California or reside in California, I understand I have the right to visually inspect the files concerning me maintained by an investigative consumer reporting agency during normal business hours and upon reasonable notice. The inspection can be done in person, and, if I appear in person and furnish proper identification; I am entitled to a copy of the file for a fee not to exceed the actual costs of duplication. I am entitled to be accompanied by o ne person of my choosing, who shall furnish reasonable identification. The inspection can also be done via certified mail if I make a written request, with proper identification, for copies to be sent to a specified addressee. I can also request a summary of the information to be provided by telephone if I make a written request, with proper identification for telephone disclosure, and the toll charge, if any, for the telephone call is prepaid by or directly charged to me. I further understand that the investigative consumer reporting agency shall provide trained personnel to explain to me any of the information furnished to me; I shall receive from the investigative consumer reporting agency a written explanation of any coded information contained in files maintained on me. “Proper identification” as used in this p aragraph means information generally deemed sufficient to identify a person, including documents such as a valid driver’s license, social security account number, military identification card and credit cards. I understand that I can access the following website http://sterlinginfosystems.com/privacy to view STERLING’S privacy practices, including information with respect to STERLING’S preparation and processing of investigative consumer reports and guidance as to whether my personal information will be sent outside the United States or its territories.
Signature
Today’s Date (MMDDYYYY)
For Office Use Only – Group ID (optional)
D E L
O R O
D I V I S
I O N
For Office Use Only – User ID (optional)
For Office Use Only – Location / Store # (optional)
www.sterlinginfosystems.com Page 2 of 5 249 West 17th Street, 6th Floor, New York, NY 10011 Telephone 877-424-2457 Facsimile 646-536-5239 09/2012
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Job Applying for: Volunteer First Name
Middle Name or Initial
Last Name
Date of Birth (MMDDYYYY)
Male
Female
Other Names Known By
Social Security Number
✔
Primary Telephone Number (no dashes)
Volunteer Driver (MVR) DOT Driver
Driver’s License Number (no dashes)
License State
Email Address
Current Address Provide all residential addresses for the last seven (7) years
Apt #
City
State
Previous Address – 1 (if above does not equal 7 years)
Apt #
City
State
Previous Address – 2 (if above does not equal 7 years)
Apt #
City
State
Previous Address – 3 (if above does not equal 7 years)
Apt #
City
State
Previous Address – 4 (if above does not equal 7 years)
Apt #
City
State
#yrs. at this address
Zip Code
#yrs. at this address
Zip Code
#yrs. at this address
Zip Code
#yrs. at this address
Zip Code
#yrs. at this address
Zip Code
Today’s date (DDMMYYYY) Signature www.sterlinginfosystems.com Page 3 of 5 249 West 17th Street, 6th Floor, New York, NY 10011 Telephone 877-424-2457 Facsimile 646-536-5239 09/2012
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Volunteer Copy ONLY Para informacion en espanol, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington DC 20006. A Summary of Your Rights Under the Fair Credit Reporting Act The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to www.consumerfinance.gov/learnmoreorwrite to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington DC 20006. • You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment – or to take another adverse action against you– must tell you, and must give you the name, address, and phone number of the agency that provided the information. • You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if: • A person has taken adverse action against you because of information in your credit report; •you are the victim of identity theft and place a fraud alert in your file; •your file contains inaccurate information as a result of fraud; •you are on public assistance; •you are unemployed but expect to apply for employment within 60 days. In addition, all consumers are entitled to one free disclosure every12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnmorefor additional information. • You have the right to ask fora credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender. • You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.consumerfinance.gov/learnmorefor an explanation of dispute procedures. • Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate. • Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10years old. • Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need– usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access. • You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go towww.consumerfinance.gov/learnmore. • You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. Unsolicited “prescreened” offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-567-8688.
www.sterlinginfosystems.com Page 4 of 5 249 West 17th Street, 6th Floor, New York, NY 10011 Telephone 877-424-2457 Facsimile 646-536-5239 9/2012
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Volunteer Copy ONLY • You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court. • Identity theft victims and active duty military personnel have additional rights. For more information, visit www.consumerfinance.gov/learnmore. States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. For information about your federal rights, contact: TYPE OF BUSINESS:
CONTACT:
1. a. Banks, savings associations, and credit unions with total assets of over $10 billion and their affiliates.
a. Bureau of Consumer Financial Protection 1700 G Street NW Washington, DC 20006
b. Such affiliates that are not banks, savings associations, or credit unions also should list, in addition to the Bureau:
b. Federal Trade Commission: Consumer Response Center–FCRA Washington, DC 20580 (877) 382-4357
2. To the extent not includedinitem1 above: a. National banks, federal savings associations, and federal branches and federal agencies of foreign banks
a. Office of the Comptroller of the Currency Customer Assistance Group 1301 McKinney Street, Suite3450 Houston, TX77010-9050
b. State member banks, branches and agencies of foreign banks(other than federal branches, federal agencies, and insured state branches of foreign banks), commercial lending companies owned or controlled by foreign banks, and organizations operating under section25or 25Aofthe Federal Reserve Act
b. Federal Reserve Consumer Help Center P.O. Box1200 Minneapolis, MN 55480
c. Nonmember Insured Banks, Insured State Branches of Foreign Banks, and insured state savings associations
c. FDIC Consumer Response Center 1100Walnut Street, Box#11 KansasCity,MO64106
d. Federal Credit Unions
d. National Credit Union Administration Office of Consumer Protection (OCP) Division of Consumer Compliance and Outreach (DCCO) 1775 Duke Street Alexandria,VA22314 Asst. General Counsel for Aviation Enforcement & Proceedings Department of Transportation 400 Seventh Street SW Washington, DC 20590
3. Air carriers 4. Creditors Subject to Surface Transportation Board
Office of Proceedings, Surface Transportation Board Department of Transportation 1925 K Street NW Washington, DC 20423
5. Creditors Subject to Packers and Stockyards Act
Nearest Packers and Stockyards Administration area supervisor
6. Small Business Investment Companies
Associate Deputy Administrator for Capital Access United States Small Business Administration 406 Third Street, SW, 8th Floor Washington, DC 20416
7. Brokers and Dealers
Securities and Exchange Commission 100 F St NE 20549 Farm Credit Administration 1501 Farm Credit Drive Mclean, VA 22102-5090
8. Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit Banks ,and Production Credit Associations 9. Retailers, Finance Companies, and All Other Creditors Not Listed Above
Washington, DC
FTC Regional Office for region in which the creditor operates or Federal Trade Commission: Consumer Response Center–FCRA Washington, DC 20580 (877) 382-4357
www.sterlinginfosystems.com Page 5 of 5 249 West 17th Street, 6th Floor, New York, NY 10011 Telephone 877-424-2457 Facsimile 646-536-5239 9/2012
The California Child Abuse Reporting Law Due to recent negative publicity regarding work with children, the Legislature now has added new section to the California Penal Code. All "child care custodians" employed after 1/ must sign a statement to the effect that he/she has knowledge of the provisions of this new section and will comply with it. The code section is cited below for your review and signature. Section 11166 of California Penal Code requires any child care custodian, medical practitioner, non-medical practitioner, or employee of the child protective agency who has knowledge of or observed a child in his or her professional capacity or within the scope of his or her employment whom he or she knows or reasonably suspects has been the victim of a child abuse to report the known or suspected instance of child abuse to a child protective agency immediately or as soon as practically possible by .telephone and to prepare and scud a written report thereof within 36 hours of receiving the information concerning the incident. "Child care custodians" include teachers, instructional aides, teacher's aides, teacher's assistants, administrative officers, supervisors of child welfare and attendance, or certificated private schools; administrators of a public or private day camp; licensees, administrators and employers of community care facilities or child day care facilities licensed to care for children; Headstart teachers; licensing workers or licensing evaluators; public assistance workers; employees of a child care institution including, but not limited w, foster parents, group home personnel, and personnel of residential care facilities; and social workers or probation officers. "Medical practitioner" includes physicians and surgeons, psychiatrists, psychologists, dentists, residents, interns, podiatrists, chiropractors, licensed nurses, dental hygienists, or any other person who is licensed under Division 2 (commencing With Section 500) of the California Business and Professions Code or emergency medical technicians I or B, paramedics, or other persons certified pursuant to the Division 2.5 (commencing with Section 1797) of the California Health and Safety Code, or psychological assistants registered pursuant to Section 2913 of the California Business and Professions Code. . "Non-medical practitioner" includes state or county public health employees who treat minors for venereal disease or any other conditions; coroners; paramedics; marriage, family or child counselors; and religious practitioners who diagnose, examine or treat children. "Child protective agency" means a police or sheriff's department, a county probation department, or a county welfare department. . I acknowledge that I have read the above statement and agree to comply with it.
______________________ Signature
____________ Date
Del Oro Division Volunteers Code of Ethics for Assisting with Minors and Vulnerable Adults The Salvation Army volunteer will conduct themselves in a manner that is consistent with the discipline and teachings of The Salvation Army within the course of their duties. The Salvation Army volunteer will do their utmost to prevent abuse and neglect among minors and vulnerable adults involved in army activities and services. The Salvation Army volunteer will not physically, sexually or emotionally abuse or neglect a minor or vulnerable adult. The Salvation Army volunteer will share concerns about inappropriate behavior or policy violations with their supervisor. The Salvation Army volunteer will obey the laws and report any suspected abuse or neglect of a minor or vulnerable adult whether on or off Salvation Army property, whether perpetrated by Army volunteer or others, to the governmental authorities. The Salvation Army volunteer understand that The Salvation Army will not tolerate abuse and agree to comply in spirit and in action with this position. The Salvation Army volunteer will accept their personal responsibility to protect minors and vulnerable adults from all forms of abuse. The Salvation Army volunteer will do their utmost to use all opportunities to be a source of help to families in which abuse and neglect of a minor or vulnerable adult has become a problem. The Salvation Army volunteer will be transparent in ALL of their communications with minors, be they electronic or in person: understanding it is their responsibility, as the adult, to find ways to build that transparency and accountability into ALL of their interactions with minors.
Acknowledgement
I understand the policies and voluntarily agree to abide by these policies and conduct myself in complete accordance with them. Volunteer Print Name: __________________________________ Signature: ______________________________ Date: _____________ Witness: Print Name: __________________________________ Signature: ______________________________ Date: _____________
Code of Ethics Working with Minors – Volunteer 022519
CONFIDENTIAL THE SALVATION ARMY STATEMENT OF VOLUNTEERS (SALVATIONISTS AND NON-SALVATIONISTS) FOR WORK WITH CHILDREN * This statement will be completed by all applicants for volunteer work 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 Name Last
First
Number Street
City
Middle
Present Address
Home Phone (
State
Zip
)
Social Security No. 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 #
Telephone #
All prior work with children (List the church or other organization conducting the program, the name of the immediate supervisor and, if known, the name, address and telephone number of any individual now involved in the program.)
STATEMENT OF VOLUNTEERS (SALVATIONISTS AND NON-SALVATIONISTS) FOR WORK WITH CHILDREN
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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: 1.
In my prior volunteer work, I have never used a name other than that set forth above.
2.
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:
3.
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:
4.
I have never been arrested as a result of a charge of child abuse or of actual or attempted sexual molestation of a child.
5.
I have never been convicted of child abuse or a crime involving actual or attempted sexual molestation of a child.
6.
I authorize any of the churches or other organizations and their representatives and my personal references listed above to give to 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.
7.
I am aware that The Salvation Army is a branch of the Christian Church and 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.
8.
Having provided the foregoing information and having affirmed the foregoing statements are true, I recognize that any false information or statements are punishable under the laws relating to perjury.
Applicant Date
Signature of Witness Name Please Print Address
City
State
Zip
20
STATEMENT OF VOLUNTEERS (SALVATIONISTS AND NON-SALVATIONISTS) FOR WORK WITH CHILDREN
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(The remaining sections are to be completed by Salvation Army personnel) 1.
All references identified above have been contacted and There were no reports of misconduct involving children. Misconduct involving children was reported – applicant is not approved for work with children and name has been reported to headquarters for inclusion in the Territorial Registry.
Immediate Supervising Officer 2.
Date
Applicant’s name has been checked in the Territorial Registry and The applicant’s name did not appear in the Territorial Registry. The applicant’s name appeared in the Territorial Registry – applicant is not approved for work with children.
Responsible Officer at THQ/DHQ/CFOT/SFOT/ARC, etc. 3.
Date
Applicant’s name has been checked in available State databases and There were no reports of misconduct involving children. Misconduct involving children was reported – applicant is not approved for work with children and name has been reported to the Secretary for Personnel for inclusion in the Territorial Registry.
Responsible Officer at THQ/DHQ/CFOT/SFOT/ARC, etc. 4.*
Date
Prior accusations of abuse have been investigated and There was no reasonable suspicion of abuse There was reasonable suspicion of abuse – applicant is not approved for work with children and name has been reported to headquarters for inclusion in the Territorial Registry.
Immediate Supervising Officer *
Date
To be completed only if applicant reports an accusation in response to item # 3 of Statement.
The next forms should be signed AFTER you have received the Background Clearance Memo.
The Salvation Army Del Oro Division Volunteer Agreement for long term positions of great responsibility. This agreement is intended to underline the significance of your commitment to serve people through The Salvation Army as a volunteer. The intent of the agreement is to assure you both of our deep appreciation for your services and to indicate our commitment to do the very best we can to make your volunteer experience here a productive and rewarding one. I. The Salvation Army Del Oro agrees to accept the services of ____________________________________________ (volunteer), beginning _____________________, and we commit to the following: 1. 2.
3. 4. 5.
II.
To provide adequate information, training, and assistance for the volunteer to be able to meet the responsibilities of the position. To ensure diligent supervisory aid to the volunteer and to provide feedback on performance on a biannual basis, or at the end of the term of service (if prior to six months). To respect the skills, dignity, and individual needs of the volunteer and to do our best to adjust to these requirements. To be receptive to any comments from the volunteer regarding ways in which we might mutually better accomplish our respective tasks. To treat the volunteer as a partner with agency staff, jointly responsible for the accomplishment of the agency mission. Volunteer
I, _____________________________________, agree to serve as a volunteer and commit to the following: 1.
To perform my volunteer duties as assigned to the best of my ability.
To adhere to Salvation Army rules and procedures, including recordkeeping requirements and confidentiality of The Salvation Army and client information. 3. To meet time and duty commitment, or to provide adequate notice (24 hours minimum) so that alternative arrangements can be made. 4. To act at all times as a member of the team responsible for accomplishing the mission of the agency. 5. (Optional) I commit to volunteer for no less than ________ months from the signing date of this agreement. 2.
III.
Agreed to:
Volunteer: _________________________________ Date: ____________ TSA Representative: _________________________________ Date: ____________
1
Policies and Code of Conduct for Use of Social Media and Other Electronic Communication with Minors A. INTRODUCTION AND RATIONALE The Salvation Army values the power of social media and other forms of Electronic Communication to spread the gospel, facilitate the provision of services, encourage holy living, and promote the community-building activities of its members and supporters. The Salvation Army is also concerned with the safety of Minors in the constantly changing technological landscape, which presents both great opportunities and serious risks to Minors and the officers, cadets, employees, volunteers and others who work with and serve Minors through Army programs, events and functions. The following Policies, together will all other applicable laws, regulations, and Army policies, apply to all Electronic Communications by Salvation Army Personnel through Electronic Resources. Failure to comply with any of the provisions of these guidelines is grounds for discipline, up to and including the termination of employment or dismissal, as the case may be. For purposes of this Policy: •
A "Minor" is a person under the age of 18 years of age whom Salvation Army Personnel contact in their capacity as Salvation Army Personnel, except that the Policies and Code of Conduct below shall not apply to a Minor that is related to that member of Salvation Army Personnel;
•
"Electronic Communications" includes all communication utilizing an electronic device (e.g., phones, computers, tablets or any similar devices);
•
“Electronic Resources” includes the following: (a) all servers, information systems, back-up media, desktop and laptop computers, mobile devices (e.g., smartphones and tablets), Internet access, intranet, telephones, voice mail, fax machines and scanners and other electronic storage and communications devices and systems that are owned, leased or paid for by The Salvation Army; (b) all Electronic Communications sent or received using The Salvation Army’s Electronic Resources; and (c) all activities using any third-party communications service, such as cell phone, text messaging, or instant messaging services, for which The Salvation Army is the subscriber or for which The Salvation Army pays directly or indirectly through reimbursement to an employee.
•
“Salvation Army Personnel” includes officers, cadets, employees, volunteers, trainees, and other persons that work with or serve Minors through Army programs, events, and functions.
Social Media and Other Electronic Communication w/ Minors / Page 1 of 4
B.
POLICIES AND CODE OF CONDUCT FOR SALVATION ARMY PERSONNEL
1. All Salvation Army Personnel must acknowledge receiving, reading and understanding the requirements of this Policy before they are permitted to work with Minors in Army programs, events or functions. 2. Unless the Secretary for Personnel or his or her designee approves an exception, Electronic Communications with Minors should only be carried out through an official Salvation Army social media presence, such as an organizational social networking account, an official Facebook page, or through a Salvation Army email address. Any Salvation Army social networking account used by Salvation Army Personnel to communicate with Minors must be approved by, and is subject to monitoring by, The Salvation Army. 3. Salvation Army Personnel may not conduct Electronic Communications with Minors via (SMS) text messages or other similar form of electronic messaging or communication. In the event of a report or concern that communications prohibited by these Guidelines or Code of Ethics has occurred, the individual whose signature appears below consents to giving The Salvation Army to access to his or her electronic device(s) and related records for the purpose of determining whether a prohibited communication has occurred. 4. Local units may set up organizational accounts on social network sites that participants may join for news and updates on program-related information and activities. Corps officers and other program leaders must be given the necessary user names, passwords, and permission to access and administer such accounts and will have the ability to monitor the accounts at any time. Salvation Army Personnel will comply with the National Minute entitled "Internet Blogging/Podcasts and Web Communities" (as it may be amended or superseded) with respect to all such accounts. 5. The Salvation Army is committed to maintaining transparency and monitoring appropriate content of all Electronic Communication. Electronic messaging should primarily be utilized to communicate with youth about specific program-related information. All ministry communications, (i.e. prayer requests) between Salvation Army personnel and Minors are subject to monitoring by authorized Salvation Army representatives. 6. Prior to any Electronic Communication with a Minor, the parent or guardian of the Minor must give written consent to any such Electronic Communication which should include a description of the nature and purpose of the Electronic Communication. The parent(s) or guardian(s) of the Minor program participants must be invited to participate in social media groups or pages. 7. Personal identifiable information, photos or videos of Minors will not be included in Salvation Army social media groups or pages unless prior written permission is given by the Minor’s parent or legal guardian. Only first (given) names of Minors should be used to identify Minors in photos or videos. 8. Electronic messages must not be unlawful, obscene, discriminatory, or intended to threaten, intimidate, abuse, harass, or bully another person. Discriminatory messages include any words or images that contain sexual implications; racial slurs; or negative comments regarding age, gender, sexual orientation, religious or political beliefs, national origin or disability, or any other protected characteristic. The Salvation
Social Media and Other Electronic Communication w/ Minors / Page 2 of 4
Army will not tolerate, and reserves the right to remove, any harmful, derogatory, defamatory, obscene or otherwise potentially embarrassing content from Salvation Army organizational accounts, and to block any individual from access to a website or social networking group from Salvation Army Electronic Resources in its sole discretion. 9. Salvation Army Personnel must not intentionally exchange, transmit, solicit, or receive and retain any sexually explicit material in writing, images, video, audio, or any other form on Salvation Army Electronic Resources or on an official Salvation Army social media presence. Any Salvation Army Personnel who inadvertently receives such sexually explicit material must follow the steps prescribed in the "Responding and Reporting" section below. Salvation Army Personnel must not transmit any sexually explicit material to a minor, regardless of whether the material is transmitted from Salvation Army Electronic Resources or an official Salvation Army social media presence. Moreover, such a transmission may violate federal and state criminal laws. The transmission of any sexually explicit material to a minor is also considered child sexual abuse within the meaning of The Salvation Army’s National Policy Statement on Sexual Abuse of Children. Any sexually explicit image of a minor is child pornography and subject to applicable child pornography production, possession and distribution laws. 10. Upon the termination by Salvation Army Personnel of their relationship with The Salvation Army, no further Electronic Communication may be made with a Minor in the name of The Salvation Army. C.
TRAINING OF SALVATION ARMY PERSONNEL
Prior to working with Minors, Salvation Army Personnel should be trained with respect to the Policies and Code of Conduct in accordance with the minimum training requirements established by the Protecting the Mission department. Retraining should be performed when substantive changes to the policy have been made or as the local unit deems appropriate or necessary. D.
EDUCATION OF MINORS
1. Minors involved in Army programs should be made aware of applicable Policies and other safeguards and requirements before being allowed to use Salvation Army computers or participate in Electronic Communications with Salvation Army Personnel. 2. Minors should be told that any sexually explicit image of Minors is considered child pornography, even if the minor created the images him or herself, and that, any persons in possession of these images, including the minor himself or herself, may be subject to child pornography production, possession and distribution laws. 3. Minors should be told Electronic Communications are not confidential, and that use of Salvation Army computers is monitored. 4. It is the responsibility of Salvation Army Personnel to build transparency and accountability into all of their interactions with Minors. Salvation Army Personnel will inform Minors that Electronic Communications may be monitored by authorized Salvation Army Personnel.
E.
INTERNET SAFETY RESOURCES
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1. For Parents, Children and Educators: netsmartskids.org (Safe Internet Usage: National Center for Missing and Exploited Children) 2.
Internetsafety101.org (Enough is Enough organization)
F.
RESPONDING AND REPORTING
Knowingly sending, soliciting, or receiving and retaining any sexual image of a minor or sending any sexually explicit images or words to a person under 16 year of age is a crime under Federal law. Salvation Army Personnel who discover that sexual images are being transmitted between or to Minors must immediately report this to Salvation Army leadership and to the appropriate governmental or law enforcement agency as may be required by law. Any Salvation Army Personnel receiving any sexual image of a minor on a computer, cell phone, hand-held device, or other electronic means owned or provided by The Salvation Army should take the following steps immediately: 1.
Close the image (Do not delete, forward or show to anyone else).
2.
Contact your Salvation Army leadership and report what happened.
3.
Contact your local law enforcement and make a report about what happened.
4. Understand you may need to surrender the computer, cell phone or hand-held device to law enforcement. Acknowledgment I acknowledge that I have received a copy of the Policies and Code of Conduct for Use of Social Media and Other Electronic Communication with Minors, which I have read and understand. I further understand I am required to comply with all of the duties and obligations, set forth in the Policies and Code of Conduct (as it may be amended or superseded) as they relate to Electronic Communications with Minors. Signature: Date:
__________________________________________________________ __________________________________________________________
Print Name: Position: Corps/Unit:
__________________________________________________________ __________________________________________________________ __________________________________________________________
Social Media and Other Electronic Communication w/ Minors / Page 4 of 4
Importan t: All VOLUNTEER Salvation Army disaster workers, aged 18 & older, must have a signed Waiver of Liability on file. Please complete the following form and return this fun to your local Salvation Army unit. Please print legibly! PLEASE READ CAREFULLY! THIS lS A LEGAL DOCUMENT!
Volunteer Release and Waiver of Liability This release and Waiver of Liability (the “'Release") executed on this _________________ day of ___________________________, by (the "Participant ") in favor of THE SALVATION ARMY, a non-profit corporation organized and existing under the laws of the State of Georgia, USA, its directors, officers, employees, volunteers and agents (collectively, "The Salvation Army").
I, _____________________________________________ the Participant, desire to volunteer with The Salvation Army to provide program assistance and transportation and engage in the activities related to offering these services. I understand that the activities may include, but are not limited to, transportation in a personally owned vehicle, and delivery of food and equipment/material items. I hereby, freely and voluntarily, without duress, execute the Release under the following terms : 1.
Waiver and Release. I,___________________________________________, the Participant, release and forever discharge and hold harmless The Salvation Army from any claim or liability that I,, ___________________________________ the Participant, may have against The Salvation Army with respect to any bodily injury, personal injury, illness, death or property damage that may result from my participation in a disaster relief operation. I also understand that The Salvation Army does not assume any responsibility or obligation to provide financial or other assistance, including, but not limited to medical, health, or disability insurance, in the event of injury, illness, death or property damage (see insurance requirements below).
2.
The Salvation Army does not carry or maintain, and expressly disclaims responsibility for providing any health, medical or disability insurance coverage for the Participant. EACH PARTICIPANT IS EXPECTED AND ENCOURAGED TO CARRY PERSONAL LIABILITY, VEHICLE AND/OR HEALTH of INSURANCE PRIOR TO REGISTERJNG AS A SALVATION ARMY DISASTER WORKER.
3.
Medical Treatment. Except as otherwise agreed to by The Salvation Army in writing, I hereby release and forever discharge The Salvation Army from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my time with The Salvation Army.
4.
Assumption of Risk. I understand that my time with The Salvation Army may include activities that may be hazardous to me, including, but not limited to, cook and food preparation activities, loading and unloading of heavy equipment and materials, transportation to and from the disaster site, and working in locations damaged by the effects of a disaster. I recognize and understand that my time with The Salvation Army may, in some situations, involve inherently dangerous activities. I hereby expressly and specifically assume the risk of injury or harm in these activities and release The Salvation Army from all liability for injury, illness, death or property damage resulting from the activities of my t i m e with The Salvation Army
5.
Photogr aphic Release. I, _ __ __ __ _ __ _ __ __ _ __ __ _ __. grant and convey unto The Salvation Anny all right, title and interest in any and all photographic images and video or audio recordings made by The Salvation Army during my work for The Salvation Army, including, but not limited to, any royalties, proceeds or other benefits derived from such photographs or recordings.
6.
Other. I understand that it is my desire to further the work of The Salvation Army by performing services as a Volunteer, specifically as a Volunteer in Emergency Disaster Services. I undertake to perform said services as a Volunteer without compensation and that, in performing said services, I acknowledge that I am not acting as an employee of The Salvation Army
To express my understanding of this Release, 1 sign here with a witness. Participants Name (please print): ______________________________________________________________________________________ Participants Signature: _________________________________________________________
Date: _____________________________
Witness Name (please print): _________________________________________________________________________________________ Witness Signature: ____________________________________________________________
Date: ____________________________
Parent/Guardian (please print): _______________________________________________________________________________________ Parent/Guardian Signature: _____________________________________________________
Date: _____________________________ November 2008
