Volunteer Application

Background Check Consent
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP
Email*
Phone*
SSN*

for background check
Date of Birth*
MM slash DD slash YYYY
Driver's License Number*
Consent*
I authorize this background check.
I hereby authorize Living Alternatives to conduct a background check on me. I understand that this background check will cover information including, but not limited to, criminal history, education and employment. I hereby release Living Alternatives and its staff, employees, and board, as well as the Company performing the background check and its employees, from all liability resulting from the furnishing of this information to Living Alternatives.

I certify that the statements made by me on this form are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. I understand that any false statements made herein could void my consideration as a Living Alternatives volunteer.

Medical/Insurance Waiver
I understand that the PRC/PMC does not carry insurance that covers injury to a volunteer.
Select one:*
- I carry adequate medical insurance and I accept full responsibility for medical costs associated with an accidental injury while volunteering at the PRC/PMC.
- I do not carry medical insurance and I accept full responsibility for medical costs associated with an accidental injury while volunteering at the PRC/PMC.
- I am interested in learning how to purchase my own medical insurance.
By checking the box below you agree to release PRC/PMC and its staff/volunteers from any and all liability.*
I agree.
Name of Insurance Carrier:

Confidentiality Agreement
I understand that all PRC/PMC information could be sensitive and confidential in nature, and I promise to maintain the confidentiality of all information to which I have access. I also commit to exercise discretion in conversation within the PRC, always cognizant of the potential for someone overhearing. I understand that personnel and client information is to be discussed only with appropriate personnel in private areas where others may not overhear and will keep all such information in the strictest confidence, even after I am no longer associated with the PRC/PMC. I agree not to discuss PRC/PMC business affairs with anyone outside of the organization. I also promise to apply biblical principles to all my conversations, communications and problem solving. I understand that violation of this policy is serious and will require investigation by the Executive Director and possibly result in immediate termination.
Consent*
I understand and agree to the Confidentiality Agreement.

Volunteer Acknowledgement
The Volunteer Handbook describes important information about the PRC/PMC. I understand that I should consult the manager of my department or the CEO/Executive Director, regarding any questions not answered in the handbook. I have entered into this volunteer relationship with PRC/PMC voluntarily and acknowledge that I am not an employee and this manual is not a contract of employment. Accordingly, either I or PRC/PMC may terminate the relationship at will, with or without cause, at any time. I have received the handbook, and I understand that it is my responsibility to read and comply with the policies contained in this handbook and any revisions made to it. By signing herein, I also acknowledge and fully agree with PRC/PMC's Statement of Faith, Mission and Vision, Code of Christian Conduct, Commitment of Care and Competency and Confidentiality Policy.
Volunteer's Name*
First Last
Consent*
I understand and agree with the Volunteer Acknowledgement Statement.

Volunteer's Reference Letter
As a volunteer at Living Alternatives, we require a reference letter from your pastor, priest, or church leader. By filling out this form and entering your church leader's email, a reference request will automatically be sent to them. By giving their number, you may be able to speed up the process. Thank you so much.
Church Leader's Name*
First Last
Church Leader's Email*
Church Leader's Phone

THANK YOU!
Thank you so much for your interest in being a volunteer at Living Alternatives. We will do our best to process your application as quickly as possible. We will contact you soon.
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Background Check Consent