CORE Community Resources

14 South Broad St, PO Box 1530, Bayfield, WI 54814

715-779-3457, , , www.corecr.org

ENCORE Resale Store

10 South Broad St, Bayfield, WI 54814

715-779-3455,

Volunteer Application

Today’s Date ______

Name ______Birth Date______

First MI Last

Address ______

City/State/Zip ______

Phone numbers: Home______Work______Cell______

Email address: ______

Employer: ______

Tasks I am interested in performing:

c Working the Cash Register

c Pricing Clothing

c Pricing Housewares (non-clothing)

c Rearranging furniture

c Organizing small items, ie. greeting cards, tools, etc.

c Light cleaning/dusting

c Laundry

c Hauling donations into the store

c Testing and pricing electronics

c Ebay sales (start to finish)

c Counting and Recording daily deposits

c Planning Volunteer events and parties

c Maintenance assistance (see below)

c Facebook posts and taking photos

c Driving/Hauling bags to Goodwill or Fabric Recycle

c Making Displays

c Crafting Scarecrows, Parade Floats, etc

______

Maintenance Skills I would be willing to provide:

______

c Carpentry c Electrical

c Painting c Plumbing

c Small appliance repair c Snow Removal

c Lawn Care

c Other ______

______

Emergency Contact:

______

Name: ______Phone: ______

Address: ______

______

Screening Information

______

CORE Community Resources takes seriously its obligation to provide a safe environment for all those involved in its activities. CORE will conduct a Wisconsin Department of Justice records check on all volunteer applicants. We also request the name of a personal reference. Volunteers are asked to apply common sense and not undertake services that are unsafe or beyond reasonable expectations for the volunteer assignment that was outlined by CORE staff. Guidelines in the Volunteer Handbook are to be followed.

______

Personal Reference (please list one non-family reference)

______

Name ______Relationship to you: ______

Address______

City state zip phone number

I give my permission for CORE Community Resources to contact the above reference in regard to myself. They have my permission to obtain pertinent personal information which will be used for screening for ENCORE/CORE Community Resources’ volunteer program.

X______(Applicant Signature) (Date)

______

Background Information Disclosure

______

1. Do you have criminal charges pending against you or were you ever convicted of any crime

including federal, state, local or military and tribal courts? (include traffic violations)

c Yes c No If yes, please explain:______

2. Are you registered with Wisconsin Corrections Services/Probation and Parole: c Yes c No

3. Were you ever known by any other names (including married or maiden names) c Yes c No

If yes, what names have you used?______

I understand under penalty of law that the information provided above is truthful and accurate to the best of my knowledge. I also understand the screening requirements mentioned above, and authorize CORE Community Resources to process the paperwork for the criminal background check and driver's license check and to contact my personal references.

X ______

(Applicant Signature) (Date)

______

Liability Coverage

______

General Liability: I understand that I may not have coverage for my activities as a volunteer for ENCORE/CORE Community Resources.

X ______

(Applicant Signature) (Date)

______

Confidentiality Agreement

______

All individuals serving in a volunteer position with CORE Community Resources are to respect the confidentiality rights of those receiving care through this organization. No volunteer is to disclose confidential information to any person who is not a CORE Community Resources staff person.

All volunteers share the responsibility of adhering to and enforcing the confidentiality policy. Conflict should be brought to the attention of staff. Disciplinary action for violation of the confidentiality policy will follow approved procedures for volunteers. All volunteers are required to sign this agreement and will be informed of this policy during orientation time.

X ______

(Applicant Signature) (Date)