Please complete this application form if you are interested in becoming a Urban Ministries of Wake County volunteer. Once you complete the form, click the submit button at the bottom. Please note: we do not have night or weekend shifts and hours are listed for each position. Thank you!


Name and address


Demographic Information

This information is used only to help us get a better idea of the demographic make-up of our volunteers.


All volunteers must be 18 years of age or older. We also offer group volunteer opportunities for supervised ages 8-17. Please email the volunteer@urbanmin.org for more information.



Affiliations

Are you part of other community organizations? This information helps us get to know you better and supports Urban Ministries vibrant and growing community of volunteers.



Volunteer Positions

Please indicate all volunteer positions you are interested in. Click on the position to learn more about that role and volunteer shift times.



Languages

Please select any languages you can comfortably speak



Emergency Contact


Photography and Video Release

I grant Urban Ministries permission to use any photos taken of me on premise or at events for marketing purposes (website, flyers and brochures, social media, etc.)



Client/Patient Privacy and Confidentiality

Do you or does anyone in your family currently receive services from Urban Ministries of Wake County? Please note that current clients and patients (or their family members) cannot volunteer in our clinic at this time due to HIPAA confidentiality.



History

Have you been charged or convicted of the following.

1. A felony

2. Any crime involving a sex offence, an assault or the use of a weapon

3. Any crime involving the use, possession or the furnishing of drugs or hypodermic syringes

4. Reckless driving, operating a motor vehicle under the influence or driving endangered



Court Mandated Community Service


Notes/Other Comments:

Please add additional information you would like Urban Ministries to know.



Anti-Discrimination and Harassment Policy

It is the policy of Urban Ministries of Wake County to provide volunteer opportunities at all times without discrimination on the basis of race, color, religion, sex, sexual orientation, national origin, qualified disability, age (40 years of age or older), veteran status or other characteristic or activity protected by federal, state or local law. In addition, harassment of volunteers by Agency employees including co-workers, supervisors, managers and executives, as well as any non-employees based on race, color, religion, sex, sexual orientation, national origin, qualified disability, age (40 years of age or older), veteran status or other characteristic or activity protected by federal, state or local law is unacceptable conduct, which will not be tolerated.

1. General Policy Statement on Harassment

Urban Ministries of Wake County believes that all volunteers are entitled to work in an environment free from harassment,

intimidation and coercion, allowing each volunteer to reach his/her full potential. This policy applies to harassment by any

Agency employees, including co-workers, supervisors, managers and executives, as well as any non-employees present in

Urban Ministries’ workplace or interacting with Urban Ministries’ employees in connection with their work. Such prohibited

harassment can arise from a broad range of physical or verbal behavior, which may include, but is not limited to, the

following:

a. Physical or mental abuse;

b. Insults, jokes, slurs or comments based on an individual’s race, color, religion, sex, sexual orientation, national

origin, qualified disability, age (40 years of age or older), veteran status or other characteristic or activity protected

by federal, state or local laws; or

c. Display of suggestive, offensive or discrimination-oriented pictures or materials.

2. Sexual Harassment

Sexual harassment is a specific form of illegal harassment that requires more explanation. Urban Ministries bases its

definition of sexual harassment on information provided by the Equal Employment Opportunity Commission (EEOC).

According to EEOC guidelines, sexual harassment includes, but is not necessarily limited to, unwelcome sexual advances,

requests for sexual favors and other verbal or physical conduct of a sexual nature when:

a. Submission to or rejection of such conduct explicitly or implicitly affects an individual’s volunteering;

b. Submission to or rejection of such conduct by an individual is used as the basis for volunteer decisions affecting

such individual; or

c. Such conduct unreasonably interferes with an individual’ work performance or creates an intimidating, hostile

or offensive work environment.

d. Sexual harassment can occur in a variety of circumstances, including but not limited to, the following:

i. The victim as well as the harasser may be a woman or man. The victim does not have to be of the

opposite sex.

ii. The harasser can be the victim’s supervisor, an agent of the employer, a supervisor in another area, a

co-volunteer or a non-employee.

iii. The victim does not have to be the person harassed, but could be anyone affected by the offensive

conduct.

iv. Unlawful sexual harassment may occur without economic injury to or discharge of the victim.

v. The harasser’s conduct must be unwelcome.

3. Complaint Procedure

It is the shared obligation of all employees to report any and all incidents of suspected harassment to the Executive Director. Any volunteer who believes he or she has been subjected to unlawful harassment, or who believes he or she has witnessed one or more incidents of unlawful harassment, should immediately report the incident or incidents to his or her immediate supervisor, or, alternatively, to any other supervisor, and to the Executive Director.

Acknowledgement of Harassment Policy

I have read the Urban Ministries of Wake County’s Harassment Policy. I agree that I will report any and all incidents of

harassment, of which I am aware, to my supervisor, or, alternatively, to any other supervisor and to the Executive Director. I

understand that if I feel that it is necessary or justified by circumstances, I should report the harassment or any retaliatory action to the

Executive Director. I understand that any violation of the Harassment Policy may be grounds for disciplinary action up to and

including termination.

I WILL ABIDE BY THE RULES AND POLICIES SET FORTH IN THIS DOCUMENT



Volunteer/Participant Release and Confidentiality

RELEASE OF LIABILITY:

In consideration of Urban Ministries of Wake County, Inc. accepting me as a volunteer, I hereby agree to indemnify, defend and hold harmless Urban Ministries of Wake County, Inc., its employees, or directors for any damages, loss or injuries I may sustain during my volunteer activities. I acknowledge and understand that as a volunteer, I am not covered by Urban Ministries of Wake County, Inc.’s Workers Compensation or any other insurance policy for any damages or injuries I may sustain during my volunteer activities.

USE OF PERSONAL VEHICLES:

I acknowledge and understand that any volunteers, employees, clients, or persons otherwise associated with Urban Ministries of Wake County, Inc. may not be transported in my vehicle or any other personal vehicles. I understand and acknowledge that non-compliance with this rule could result in dismissal of my services.

CONFIDENTIALITY:

By reason of job duties, volunteers may come into possession of information or have knowledge of information concerning services performed, even though they may not take any direct part in or furnish the services performed for patients or clients. The services Urban Ministries of Wake County, Inc. performs for its patients and its clients are confidential. Urban Ministries of Wake County, Inc. has both a legal and ethical obligation to protect sensitive client and patient-related data in the delivery of services.

I understand that as a volunteer at Urban Ministries of Wake County, Inc. I will be exposed to many types of confidential information, such as patient services and diagnoses, client information, financial data, employees and operations information. This information may be accessed through traditional paper files, online, or through a networked computer; regardless of the method, the requirement for protecting this data remains the same.

Except as directed by organizational or departmental policy and/or practice, volunteers may not at any time disclose any such services or information to any person whatsoever or permit any person whatsoever to examine or make copies of reports or documents that have in any way to do with the clients, patients, employees, financial information or operations of Urban Ministries of Wake County, Inc. Volunteers may not seek any confidential information concerning clients, patients, employees, financial information or operations except as required in the performance of their duties. In instances where information is stored electronically, volunteers will be provided with an appropriate user ID and password to access the appropriate level of information. The disclosure of confidential information, or the pursuit of confidential information which is not required in the performance of a job, may cause irreparable injury to the client, patient, employee or organization. Disciplinary action, up to and including discharge, and/or legal remedies may be sought against any volunteer who violates this confidentiality policy. If I am uncertain about the confidentiality of a matter, I understand that I may discuss the issue with my program director or Human Resources for clarification.

CELL PHONE WITH CAMERAS/RECORDING DEVICES

The use of camera phones, PDA’s or any other audio or video recording device with the ability to take pictures are prohibited for use of such purposes on agency property. Taking any kind of photo or video or transmitting a photo is strictly prohibited in areas where employees, visitors, clients etc. would have a reasonable expectation of privacy. Recording or transmitting of any personnel records or other confidential information to include but not limited to any agency information, logos, data, photos of the premises or of any employee, client, volunteer and/or visitor is strictly prohibited. Volunteers violating this policy will be disciplined and appropriate action taken up to and including termination.


I have read and understand this volunteer release and confidentiality form. I agree that I will comply with the policies outlined here at all times during my tenure as a volunteer with Urban Ministries of Wake County, Inc.