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Please complete and submit the form below.
I understand that Family Service may request a PA Criminal Record Check on my behalf.
I understand that all Family Service sites are Tobacco-Free. Smoking and other forms of tobacco use by employees, volunteers, independent contractors and vendors will not be permitted in any building or on agency campuses, including parking lots.
As a volunteer with Family Service Association of Bucks County (Family Service), I understand that I may have access to confidential information.
Confidential information may include, but is not limited to, information relating to:
As a Family Service volunteer, I understand that I am to use confidential information only as needed to perform assigned volunteer duties and to:
Therefore, I agree that I will not in any way divulge copy, release, sell loan, review, alter or destroy any confidential information except as properly authorized within the scope of my volunteer activities with Family Service. In addition, I accept responsibility for all activities undertaken using my login/password and other authorization. I will safeguard and will not disclose any login/password or any other authorization I have that allows me to access confidential information. Further, I understand that my obligations under this agreement continue after I cease to volunteer with Family Service.
I understand that in order to promote the safety of employees, clients and agency visitors, as well as the security of the agency, Family Service may conduct video surveillance of any portion of its premises at any time, the only exception being private areas of restrooms and lunchrooms. Video cameras will be positioned in appropriate places within and around Family Service buildings and used in order to help promote the safety and security of people and property. I hereby give my consent to such video surveillance at any time the company may choose.
I hereby release Family Service from all liability, including liability for negligence associated with enforcement of these policies and/or any searches or surveillance undertaken pursuant to these policies.
This release discharges Family Service Association of Bucks County from liability in the event that I voluntarily or inadvertently disclose confidential information about myself or others. A copy of this authorization will be maintained in Family Service’s records as applicable.
Family Service is an Equal Opportunity Employer and considers all candidates for employment and volunteer service regardless of race, color, religious creed, ancestry, national origin, age, sex, handicap, or sexual orientation.
My statements and answers in the foregoing Volunteer Information, and any attachments or addenda thereto, are true and complete to the best of my knowledge. I understand that false or misleading statements may result in my being disqualified for, or terminated from, volunteer service by Family Service.
Family Service is hereby authorized to investigate any information contained in this Volunteer Information or any information related to my business background.
Director of Volunteer Services
215-757-6916, ext. 202
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