Name (First & Last): * Address * City/State/ZIP * Email: * Phone Number: *
Emergency Contact Name * Emergency Contact Phone * Relationship * Please summarize any special skills, talents, or hobbies you have: * Please summarize any previous volunteer/work experience (where, when, what you did). * List any training, related expereince, or knowledge that you have that may benefit you in this volunteer position? * How did you learn about HACAP? * What do you hope to gain from this experience? * Are you volunteering to fulfill a requirement for a class or school program? * Yes No Are you volunteering to fulfill a legal community service requirement? * Yes No
Agreement and Electronic Signature
Disclosure of confidential information gained through your employment or as a volunteer by Hawkeye Area Community Action Program, Inc. is an act of prohibited conduct subject to formal disciplinary action. Any information concerning a client, family, financial condition or personal peculiarities is strictly confidential. When a client’s history or condition is reviewed, it must be done in privacy with only those persons involved with the client. Any other information coming to you in the course of your work concerning another person or employee is also considered confidential and may not become the topic of conversation with others.
Electronic Signature: *