Volunteer Application Form You will receive an email from the Hope Center administrative/management staff to coordinate hours to volunteer.Applicant Type(Required) Volunteer Community Service GivePulse/University Probation/Save Record of hours for two years. Please write the reason why you need to complete community service hours: * All volunteer and community service hours are deleted after one year unless you check “Probation/Save Record of hours for two years”.Name(Required) First Last Phone(Required)Email(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Gender(Required) Male Female Birth Date(Required) MM slash DD slash YYYY Is there any work you cannot perform?(Required) Work Preference(Required) Testing Electronics Hanging/Sorting Clothes Stocking Media Bike/Small Engine Repair Displays/Merchandising Janitorial Cleaning Have you ever been convicted of a felony or serious misdemeanor?(Required) Yes No If yes, please explain (include dates)(Required)Issue Leading to Arrest:(Required) Drugs Alcohol Sexual Violence Other Please Explain(Required) Please Read and Acknowledge(Required) I certify that the facts above are true and complete to the best of my knowledge and understand that falsified statements shall be grounds for dismissal. I release all parties from all liability for any damage that may result from the information here. Photo Release(Required) I understand that photos (individual and group) may be taken and I give permission for my picture and/or my son’s/daughter’s picture to be used for promotional materials (newsletter, web page, calendars, power point, etc.). All photos and copyrights belong to HOPE Center. Medical Release(Required) I authorize treatment by a licensed medical physician or licensed medical team in case of an accident or illness on HOPE Center property. I would like to be notified before the hospital personnel do any additional treatment. I understand that any expense incurred will be my responsibility Emergency(Required) In the event of an emergency or non-emergency situation requiring medical treatment, I hereby grant permission for any and all medical and/or dental attention to be administered to myself. This permission includes, but is not limited to, the administration of first aid, the use of an ambulance, and the administration of anesthesia and/or surgery, under the recommendation of qualified medical personnel. Emergency Contact Person First Last PhoneFamily Physician First Last PhoneConsent & Liability Waiver(Required) I agree to release The HOPE Center, its officers, agents, employees, volunteers, consultants, and all sponsors and/or officials and staff of any said entity or person, their representatives, agents, affiliates, directors, servants, volunteers, and employees (hereinafter referred to collectively as “Parties Released”) from the cost of any medical care that I receive while volunteering or as a result of it. I further agree to waive, release, and discharge the Parties Released from any and all liability, claims, demands, actions, and causes of action whatsoever, for any loss, claim, damage, injury, illness, attorney’s fees or harm of any kind or nature to me arising out of any and all activities associated with volunteering or as a result of it. Are you filling out this form on behalf of a minor?(Required) Yes No Consent for Minors(Required) I grant permission for my child/children, to participate in activities/duties with Hope Center and/or HOPE Center. I agree on behalf of myself, my child’s other parent if known or living, my child named herein, or our heirs, successors, and assigns, to defend the HOPE Center or any representatives associated with activities/duties. I consent to all of the items listed above under the Confidentiality, Photo Release, Medical Release and Consent & Liability sections above for my child named here. Child/Children name(s)(Required) HOPE CENTER CODE OF CONDUCT By signing below you agree to follow the guidelines in this Code of Conduct as a condition of providing services to the Hope Center. Work your shift as scheduled or call to inform management of unavailability. Dress code is modest business casual work clothes. No Yoga/Stretch Pants. No open-toed shoes. No “statement” clothing or jewelry. Questions go to the Operations Manager. Vests and name tags are provided and required when working. Upon arrival for your shift, clock in. Clock out for lunchtime. No consumption of food or drink other than breaks and lunch times. Lockers are provided for personal use. Bring your own lock. No shopping during your shift. Before, after, and breaks are fine. 20% discount is given to all workers. Items cannot be taken without payment (stealing) or for personal gain (scamming). Workers are not allowed to make deals with friends or customers. Send them to management. Conduct yourself in an appropriate manner, polite and courteous. Treat customers, staff and other volunteers with respect and consideration. Harassment, sexual or related to race, religion, gender, national origin, medical conditions or sexual orientation will not be tolerated. No Cell phones or music players use while on shift. Request special permission for necessary phone calls from managers. Keep the number of personal visitors to a minimum during your shift. Possession of or being under the influence of alcohol or an illegal drug is prohibited. We retain the right to random drug testing. Tobacco products are permitted only in the designated area. Weapons, including pocket knives are not allowed on the premises. Use of profanity is prohibited.
