Please complete this application form if you are interested in becoming a NorthWest Senior & Disability Services volunteer. Once you complete the form, click the submit button at the bottom.


Please read before completing this application.

Due to the vulnerability of the clients we serve, all volunteers are required to undergo a criminal background check as part of the volunteer screening process. After enrollment as a volunteer, background checks are conducted annually. If you have not lived in Oregon for the past five years, you will also be required to have your fingerprints run through a national database. If you do not wish to participate in a background check, do not complete this applications.



Contact Information


Demographic Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.



Volunteer Preferences

Please indicate the days and times you are usually available to volunteer.



Personal or professional references

Please provide the name, phone and or email for two non-family members and advise them to expect an inquiry.



Emergency contact

Who should we contact in the event that you become involved in an emergency situation?



Volunteer source and experience

Please share from where you learned about the Money Management Program and about any experience that you have as a volunteer or with money management.



Confidentiality Agreement

Confidentiality is the preservation of privileged information concerning a client, which is disclosed in a professional working relationship. Part of what volunteers learn is necessary to provide services to the client; other information is shared within the development of a helping, trusting relationship. Therefore, most information gained about individual clients throughout an assignment is confidential in terms of the law, and disclosure would make you legally liable. Disclosure could also damage our relationship with the client and make it difficult to help the person.


All records dealing with specific clients must be treated as confidential. General information, policy statements or statistical material not identified with any family is not classified as confidential.


Before you begin your assignment as a volunteer, you should be aware of the laws and penalties of breaching confidentiality. Violation of the Oregon Revised Statues regarding confidentiality of records is punishable upon conviction by fine of not more than $1,000,00, or by imprisonment in the county jail for not more than 60 days, or both. It also may be reason for dismissal in your position.



Hold Harmless Agreemement

I release, indemnify and hold harmless NorthWest Senior & Disability Services, its officers, agents and employees from any and all claims, actions and demands that may arise from my actions as a volunteer. I also understand that my volunteer involvement can be terminated at the discretion of the agency at any time. I understand that if I use my personal vehicle to and from y volunteer position, that I am agreeing to keep in effect automobile liability insurance equal to or greater than the minimum required by the state of Oregon.


By checking the box below I acknowledge that I understand and agree to this policy.



Password

With your email address and password you will be able to log into our on-line volunteer center to update your contact information, change your preferences, update your client information, and complete your monthly volunteer report. The link to log in is located on the Money Management Page. Passwords are not case sensitive and may be letters or numbers or a combination of both. Be sure to record your chosen password in a secure location.