Good Samaritan Ministries

Volunteer Application

Name:______Date:______

Address:______Spouse:______

City:______Vol’s Birthday:______

State, Zip:______Phone #:______

E-Mail Address:______Cell Phone:______

Vol’s Shirt Size:______Where do attend Church:______

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Have you ever done volunteer work? If you have, What Kind and Where:______

______

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Which Ministry would you like to be involved in? Choose any or all

___Client Reception ___Food Pantry ___Maintenance

___The Melting Pot ___Donation Pick up Drivers ___Heaven Sent Thrift Store

Client Receptionist: Monday-Friday 9:00a.m.-12:00p.m. & 1:00p.m.-4:00p.m.

Greet clients, assist client sign in, make copies of documentation, pull files.

Food Pantry: Monday-Friday 9:00a.m.-12:00p.m. & 1:00p.m.-4:00p.m.

Makes food boxes, stock shelves and freezers, sort food donations, clean pantry.

Pick Up Drivers: Monday, Wednesday, Friday. 9:00a.m.-12:00p.m. & 1:00p.m.-4:00p.m.

To pick up community donations of food drives, furniture, clothing, etc.

Drive to Bristol for pick up and delivery to GSM office building.

“Heaven Sent” Thrift Store: Monday- Friday 9 a.m..-4 pm. Saturday 9 am-5 pm

Volunteer to sort donations, stock shelves and hang clothing, assist customers, store maintenance, assist store manager.

Other: ___Computer Data Entry ___Computer System Installation ___Fundraising

What times would be most convenient for you? Weekdays-M T W TH F (Circle day(s)

Mornings______Afternoons______

Are you available on short notice?____ or for evening or weekend projects?____

Person to contact in case of an emergency ______Phone ______.

Which of the following best describes you:

_____ High School or College Student needing community service hours.

_____ Non-Student needing official community service hours.

_____ Client seeking volunteer hours.

_____ Person with time in their life to volunteer regularly.

_____ Person with time in their life to volunteer for special events.


Confidentiality Matters

It is against the law for you to read client files or discuss cases with anyone else, either on the telephone or in person, at the agency, or outside of the agency. You should not even reveal whether a person is a client or not.

I agree to abide by the above statement.

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Signature Date


Good Samaritan Ministries, Inc. Workplace Rules

Good Samaritan Ministries wants to encourage a safe and pleasant work atmosphere. This can only happen when everyone cooperates and commits to appropriate standards of behavior.

The following is a list of behaviors that the company considers unacceptable. Any employee or volunteer found engaging in these behaviors will be subject to disciplinary actions including reprimand, warning, layoff, or dismissal:

1.  Failure to be at the work place, ready to work, at the regular starting time.

2.  Willfully damaging, destroying or stealing property belonging to fellow employees or volunteers of the company.

3.  Fighting, cursing, engaging in horseplay or disorderly conduct.

4.  Refusing or failing to carry out any instructions of a supervisor.

5.  coming to work under the influence of alcohol or any drug or bringing alcoholic beverages or drugs onto company property.

6.  Ignoring work duties or loafing during working hours.

7.  Using threatening or abusive language toward a fellow employee or volunteer.

8.  Willfully or habitually violating safety or health regulations.

9.  Failing to wear clothing conforming to standards set by the company.

10.  Being tardy or taking unexcused absences from work.

11.  Smoking contrary to established policy or violating any other fire protection regulation. Smoking is allowed only in designated smoking areas outside.

12.  Not taking proper care of, neglecting or abusing company equipment and tools.

13.  Using company equipment in an unauthorized manner.

14.  Possessing firearms or weapons of any kind on company property.

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Employee/Volunteer Signature Date

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Supervisor’s Signature Date


Good Samaritan Ministries, Inc. Workplace Safety Rules

Your safety is the constant concern of Good Samaritan Ministries, Inc. Every precaution has been taken to provide a safe workplace. Common sense and personal interest in safety are still the greatest guarantees of your safety at work, on the road, and at home. We take your safety seriously and any willful or habitual violation of safety rules will be considered cause for dismissal. Good Samaritan Ministries, Inc. is sincerely concerned for the health and well being of each member of the team.

The cooperation of every employee and volunteer is necessary to make this company a safe place in which to work. Help yourself and others by reporting unsafe conditions or hazards immediately to your supervisor. Begin right by always thinking of safety as you perform your job, or as you learn a new one.

Accident reporting. Any injury at work – no matter how small – must be reported immediately to your supervisor and receive first aid attention. Serious conditions often arise from small injuries if they are not cared for at once.

Specific safety rules and guidelines. To ensure your safety and that of your coworkers, please observe and obey the following rules and guidelines:

·  Observe and practice the safety procedures established for the job.

·  In case of sickness or injury, no matter how slight, report at once to your supervisor. In no case should an employee or volunteer treat his/her own or someone else’s injuries or attempt to remove foreign particles from the eye.

·  In case of injury resulting in possible fracture to leg, back, or neck, or any accident resulting in an unconscious condition, or a severe head injury, the employee or volunteer is not to be moved until medical attention has been given by authorized personnel.

·  Do not wear loose clothing or jewelry around machinery. It may catch on moving equipment and cause a serious injury.

·  Never distract the attention or another employee or volunteer as you might cause him or her to be injured. If necessary to get the attention of another employee or volunteer wait until it can be done safely.

·  Where required, you must wear protective equipment, such as goggles, safety glasses, masks, gloves, hair nets, etc.

·  Pile materials, skids, bins, boxes, or other equipment so as not to block aisles, exits, fire fighting equipment, electronic lighting or power panel, valves, etc. FIRE DOORS AND AISLES MUST BE KEPT CLEAR.

·  Keep your work area clean.

·  Observe smoking regulations

·  Running and horseplay are strictly forbidden.

·  Do not block access to fire extinguishers

·  Do not tamper with electric controls or switches.

·  Do not operate machines or equipment until you have been properly instructed and authorized to do so by your supervisor.

·  Do no engage in such other practices as may be inconsistent with ordinary and reasonable common sense safety rules.

·  Report any UNSAFE condition or acts to your supervisor.

·  HELP TO PREVENT ACCIDENTS.

·  Use designated passages when moving from one place to another, never take hazardous shortcuts.

·  Lift properly – use your legs, not your back. For heavier loads, ask for assistance.

·  Do not throw objects.

·  Clean up spilled liquid, oil, or grease immediately.

·  Wear hard sole shoes and appropriate clothing. Shorts or min-dresses are not permitted.

·  Place trash and paper in proper containers and not in cans provided for cigarette butts.

Safety checklist. It’s every employee and volunteer’s responsibility to be on the lookout for possible hazards. If you spot one of the conditions on the following list – or any other possible hazardous situation – report it to your supervisor immediately.

·  Slippery floors and walkways.

·  Tripping hazards such as hose links, piping, etc.

·  Missing (or inoperative) entrance and exit signs and lighting.

·  Poorly lighted stairs.

·  Loose handrails or guard rails.

·  Loose or broken windows.

·  Dangerously piled supplies or equipment.

·  Open or broken windows.

·  Unlocked doors and gates.

·  Electrical equipment left operating.

·  Open doors on electrical panels

·  Leaks of steam, water, oil, etc.

·  Blocked aisles.

·  Blocked fire extinguishers

·  Blocked fire doors

·  Evidence of any equipment running hot or overheating.

·  Oily rags

·  Evidence of smoking in non-smoking areas.

·  Roof leaks.

·  Directional or warning signs not in place.

·  Safety devices not operating properly.

Seat belts. All employees and volunteers must use seat belts and shoulder restraints (if available) whenever they operate a vehicle on company business. The driver is responsible for seeing that all passengers in front and rear seats are buckled up.

Good housekeeping. Your work locations should be kept clean and orderly. Keep machines and other objects (merchandise, boxes, shopping carts, etc) out of the center of aisles. Clean up spills, drips, and leaks immediately to avoid slips and falls.

Place trash in the proper receptacles. Stock shelves carefully so that items will not fall over.

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Employee/Volunteer Signature Date

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Supervisor Signature Date


Good Samaritan Ministries, Inc. Emergency Instructions

Follow these rules in an emergency.

·  Stop work and leave the building IMMEDIATELY when the fire alarm sounds or when you are instruction to do so.

·  Follow instructions, avoid panic, and cooperate with those responding to the emergency.

·  Proceed to the designated or nearest exit.

·  Turn off computers, equipment, fans, etc., and close desk drawers.

·  Do NOT delay your exit from the building by looking for belongings or other people.

·  When leaving the building, go to a clear area well away from the building. Do not obstruct fire hydrants or the responding fire/rescue workers and their equipment.

·  Do no re-enter the building until instructed to do so by your supervisor or fire/rescue worker.

·  The above rules will be enforced. Periodic fire emergency drills may be conducted. Your life and the lives of others will depend on your cooperation.

If you ever discover a fire:

·  Remain calm. Do not shout “Fire.”

·  Dial “911” on the telephone and give the operator the location of the fire, the floor, wing and room number if possible.

·  Inform others in the building and evacuate as soon as possible.

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Employee/Volunteer Signature Date

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Supervisor Signature Date