Volunteer Application Posted: Sunday, July 6th, 2014 by lcadmin in Volunteer at Peter Becker Community Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Home PhoneMobile PhoneEmail Emergency Contact First Last Emergency Contact PhonePlease check all that apply to you Student College Student Retiree PBC Resident Currently Employed How often would you like to volunter? (once a week, twice a month, etc) Current OccupationSpecial Skills and Interests Please check where you would like to work:Life Enrichment Department Crafts, Quilts Friendly Visitor Worship Volunteers Transport, Wed Night, Hymn Sing Choir Administration Ridgeview Gift Shop Maple Corners Gift Shop Nursing Department Bed Making Linen Closet Abiders Fresh Water to Residents Physical Therapy Helper Sorting/Delivery of Mail Watering Plants Auxiliary Fund Raisers Beauty Shop Helper Thrift Shop Special Events What days are you available? Please list AM or PM time preferences. References (list 3 with name, address and phone) If accepted into the Volunteer Program at Peter Becker Community, I agree to: Hold as absolutely confidential all information that I may obtain directly or indirectly concerning residents and staff and not seek to obtain confidential information from a resident. Become familiar with the organizational policies and procedures and uphold PBC’s Mission and Philosophy and standards. Donate my services to PBC on a voluntary basis. I do not expect compensation or future employment for any services I provide. Be punctual and conscientious, conduct myself with dignity, courtesy, and consideration of others, and endeavor to make my work professional in quality. Maintain a well-groomed appearance and follow the Dress Code as prescribed in the Handbook. Attend orientation and in-service training as scheduled. Carry out assignments and seek the assistance of the job supervisor when needed. Take any problems, criticism or suggestions to my service area supervisor or to the Volunteer Coordinator. Adhere to the sign in procedures. Notify the volunteer office or supervisor if I will be absent from an assigned duty. Honor a minimum six-month commitment toward volunteer service with the first three months on a probationary period. I understand that the Volunteer Services Department reserved the right to terminate my volunteer status as a result of (a) failure to comply with PBC policies, rules, regulations and procedures; (b) absences without prior notification; (c) unsatisfactory attitude, work, or appearance; or (d) any other circumstances which in the judgment of the Dept Head or Volunteer Coordinator would make my continued service as a volunteer contrary to the best interests of PBC. I agree to receive the annual PPD two-stage testing for tuberculosis. Accept Agreement* I have read each of the above conditions, and I agree to be bound by them.