I have read and understand the questions asked in this volunteer application. I certify the answers I have given are true, accurate, and complete. I understand that the omission and/or misrepresentation of any fact from or on this application or during any interview will result in immediate rejection of my application or will be cause for immediate dismissal. Unless I noted otherwise, I authorize Sheppard Pratt to contact all my references. I hereby release Sheppard Pratt and all affiliated persons and entities, as well as any person or institution that provides Sheppard Pratt with any lawful information about me, from any and all liability whatsoever resulting from any such lawful inquiry, investigation, or communication.
I agree to abide by all rules and regulations of Sheppard Pratt I understand and agree that nothing in this application shall constitute an offer, a contract, or a guarantee of volunteer service or employment for a specific period of time. I understand that my volunteering may be terminated with or without cause and with or without notice at nay time, at the will of Sheppard Pratt or me. In addition, I understand that Sheppard Pratt and all plan administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance, or otherwise change all policies, procedures, or other terms and conditions of volunteering.
I consent to the use of my image in photographs, videos or recordings taken while I am volunteering at Sheppard Pratt for use in Sheppard Pratt advertising, marketing, publication, or promotion.
Volunteers at Sheppard Pratt are prohibited from talking photos, video, or voice recordings of clients, staff, or facilities unless written consent is obtained from Sheppard Pratt's Volunteer Coordinator. This includes, but is not limited to, cameras and mobile devices (cell phones, iPads, etc.). Should a volunteer violate this agreement, appropriate legal action will be taken.
CORPORATE CONFIDENTIALITY AGREEMENT
Confidential information is defined to include both Protected Health Information (PHI) and organizational information. PHI is medical information that identifies our patients or employees or may provide a basis for identifying our patients and employees, including demographic information. PHI relates to past, present or future physical or mental health condition and related health services. Organizational information is information such as personnel, clinical and business operations information.
I understand that in the performance of my duties as an employee/volunteer/contractor of Sheppard Pratt. I may e provided, come in contact with, hear, be required to have access to and/or be involved in the processing of PHI and organizational information. I understand that it is my responsibility to protect the confidentiality of both PHI and organizational information. I understand that all forms of communication are protected, i.e., written, oral, and/or electronic form.
Sheppard Pratt prohibits access to, use of, alteration of confidential information without appropriate authorization. Authorizations are granted only when reasonably necessary to meet business, employee, or patient needs. once authorized access is granted, I understand that the access to confidential information is limited by my need to know and that any confidential information gained through such access may not be used for any unauthorized purpose. I may not disclose any confidential information, without valid authorization, to anyone other than employees who have a legitimate need to know.
I understand that all PHI is confidential, and disclosure is governed by law and policy. I understand that PHI should never be discussed with anyone other than personnel directly responsible who have a need to know and never in public places. such as corridors, elevators, open offices, the cafeteria, or other places where conversations may be overheard. I will secure printed and electronic information that contains PHI from unauthorized access.
I understand that I am required to conform to state and federal laws, including the federal Health Insurance Portability Accessibility Act (HIPPA) pertaining to the privacy and security of PHI.
I understand that I am obliged to maintain the confidentiality of confidential information at all times, both at work and off duty. Accessing or disclosing confidential information without appropriate authorization, or misuse of confidential information, is a serious infraction that may result in disciplinary action, including termination. I further understand that I could be subject to legal action.
Sheppard Pratt, and it's component programs, is a non-profit organization that provides high-quality services. This agreement in its entirety as it contains critical information on the expected conduct of a volunteer, liability, and confidentiality. *If you are under 18 years of age, both you and your parent/guardian must read and sign this Volunteer Agreement.
Sheppard Pratt delivers its program with respect, compassion, and professionalism. This level of respectful, compassion, and professional behavior is required of all volunteers.
Commitment and Code of Conduct
- I will be respectful and courteous to clients, staff, fellow volunteers, and members of the public.
- I will arrive at my volunteer shifts on time, and if I cannot attend my scheduled shift, will advise my supervisor directly by phone and/or email at least 24 hours before my scheduled volunteer commitment, or as soon as reasonably possible.
- I will report al accidents or injuries that occur to program participants, volunteers, staff members, or members of the public.
- I will not engage in verbal, physical, or visual harassment of another participant, staff member, volunteer, or member of the public.
- I will not be in the possession of alcoholic beverages or illegal drugs on Sheppard Pratt program premises, nor will arrive at my volunteer shift while under the influence or drugs or alcohol.
- I will not bring onto Sheppard Pratt property any dangerous or unauthorized materials such as explosives, firearms, weapons, or other similar items.
- I will not share any confidential information, as described below under Liability Waiver and Confidentiality.
- I will not threaten or act violently towards any person.
- I will not do anything that might endanger the life, safety, health or well-being of others.
- I confirm that I have freely come to volunteer with a program that is a component of Sheppard Pratt. I understand that I will volunteer my time and my skills and seek no payment or benefit in return, other than the satisfaction of helping the organization.
- I understand Sheppard Pratt will make efforts to ensure a safe volunteer environment, but cannot guarantee that I will not encounter any risks reasonably associated with their operations.
- I further understand that if I am tasked with a duty that I do not feel comfortable or skilled to perform, I am not required to do the task. It is my responsibility to advise the staff of Sheppard Pratt that I am not comfortable with the task.
- I understand that as a volunteer for Sheppard Pratt, that I am not an employee of the organization and am not entitled to any health care or worker's compensation benefits from the organization, including treatment for any injury or conditions sustained in the course of my volunteer duties.
- I understand that I bring my personal belongings to Sheppard Pratt's premises at my own risk and Sheppard Pratt is not responsible if any of my belongings or items under my personal care are lost, damaged, or stolen in the course of my volunteer duties.
- I understand and waive and release any and all claims for myself, my heirs, executors, administrators or assigns, against Sheppard Pratt, including their employees, volunteers, and board of directors in connection with any loss of property or financial loss, and/or any injury, illness or death which may directly or indirectly result from my participation as a volunteer.
I have read and I understand Sheppard Pratt's Volunteer Agreement, which includes our Communities and Code of Conduct, Liability, and Confidentiality policies. I agree to abide by the rules described above and understand that I many be removed as a participant if I violate any of these rules.
If the applicant is under the age of 18 (a minor), a parent/guardian must sign below thereby offering consent and authorization for the applicant to volunteer with Sheppard Pratt.