IF YOU HAVE ANY TROUBLE COMPLETING THIS FORM PLEASE CONTACT HELEN AT 304-292-0101 ext 204 OR BY CELL AT 304-282-0726 IMMEDIATELY!


Please complete this application to be considered for a position as a Bartlett Housing Solutions Volunteer at our Triage Shelter and/or the West Run locations. Fields that are followed by an asterisk are required. Triage volunteers MUST interview with Helen Panzironi at 304-292-0101 ext. 204 PRIOR to signing up for a shift. You will not be able to work at Triage Shelter without approval by Helen or the Director, Keri De Masi.


Please read all documents and Bartlett Housing Policies and Procedures following this application. At the end you will find an 'Agree' check off box. By clicking 'Agree' you are indicating that you will follow all applicable organization policies and procedures, as well as applicable local, state and federal laws described herein. Please click the 'Continue' button at the bottom of the form when you are finished. Thank you!


Name and Address


Please print your name and address as it appears on your birth certificate, drivers license or other form of identification (e.g. Social Security Card).



Demographic Information


Please complete the form below, providing the information requested. It is used only to help us get a better idea of the demographic make-up of our volunteers. Bartlett Housing Solutions does not share or demographic information, unless required by law.



Availability


Please indicate your availability.


Please note: If your application is approved, you will still need to schedule yourself on the online calendar (located at the bottom of our home page on the right side where it says: Volunteer/Coordinator Sign-in). Availability is on a first come, first serve basis. You can schedule yourself for recurring shifts up to six months at a time. You CANNOT work a shift if you have not scheduled yourself FIRST online.



Email or Other Contact Preferences


Bartlett Housing Solutions will keep volunteers informed of important news, schedules, and other important information or volunteer opportunities by email or as designated in your contact preference. Please note we will not continue to send notices if your mail box is full, or if the contact information you provide is inactivated for any reason. Please contact your site supervisor if your contact information changes for any reason.



Location Preference


Please note whether you wish to work at our West Run Suites location and/or at our Triage Shelter. If your application is approved, you will be notified if you have been approved for the location you indicated.


Bartlett Housing Solutions

Nitor Suites/West Run

10 West Run Road, Suite 200

Morgantown, WV 26508


Bartlett Housing Solutions

Triage Shelter

20 Scott Avenue (former Ramada Inn)

Morgantown, WV 26508



Emergency Contact


Please provide the name, contact information and relationship of an adult we can contact in the event of an emergency.



Volunteer Preference (check all that apply)

Mandatory Reporting/Confidentiality Policy/Form


Please indicate whether you agree to abide by the WV Mandatory Reporting Law, the Bartlett Non-Disclosure of Confidential Information Policy, and will sign the Confidentiality form.



Ethics/Conflict/Media Policies

Please indicate whether you agree to abide by the Bartlett Housing Solutions Business Ethics & Conduct, Conflict of Interest and Media Policies.






Are you on probation?

Please check yes or no.



Have you every been convicted of a felony?

Please check yes or no.



Are you a student?

If you are completing volunteer service as part of a student assignment please tell us the name of the school, the course number and whether you need to complete a learning contract. Please note, it is your responsibility to ensure that all paperwork is submitted to your instructor to meet any and all class requirements.



Agreement with Terms & Policies
Please check whether you agree or disagree to comply with all terms, Policies & Procedures of Bartlett Housing Solutions, as well as applicable local, state and federal guidelines outlined below, AFTER reading the documents below.

Please note: By clicking 'Agree' you are indicating that you will follow all Bartlett Housing Policies and Procedures, as well as state and federal regulations, included herein. If you have questions please contact Helen Panzironi at 304-292-0101 ext. 204 prior to starting your shift.

MANDATORY REPORTING IN WEST VIRGINIA (WV)
Please click on the following link to review WV Mandatory Reporting requirements regarding adult and child abuse. As a volunteer at Bartlett Housing Solutions you meet the definition for a mandated reporter and are expected to follow WV Mandatory Reporting requirements. If you observe or suspect abuse, or have questions, please speak with your supervisor immediately. https://www.wvdhhr.org/report.asp

BARTLETT HOUSING, INC.
1.12 NON-DISCLOSURE OF CONFIDENTIAL INFORMATION
Effective Date: 06/27/2017 Revision Date: 04/01/2017
Any information that an employee learns about Bartlett House, Inc., or its members or donors, as a result of working for Bartlett House, Inc. that is not otherwise publicly available constitutes confidential information. Employees may not disclose confidential information to anyone who is not employed by Bartlett House, Inc. or to other persons employed by Bartlett House, Inc. who do not need to know such information to assist in rendering services.
The protection of privileged and confidential information, including trade secrets, is vital to the interests and the success of Bartlett House, Inc. The disclosure, distribution, electronic transmission or copying of Bartlett House, Inc.'s confidential information is prohibited. Such information includes, but is not limited to the following examples:
• Program and financial information, including information related to donors, and pending projects and proposals.
• Information about Clients of Bartlett House, Inc.
Employees are required to sign a non-disclosure agreement as a condition of employment. Any employee who discloses confidential Bartlett House, Inc. information will be subject to disciplinary action (including possible separation), even if he or she does not actually benefit from the disclosure of such information.
Discussions involving sensitive information should always be held in confidential settings to safeguard the confidentiality of the information. Conversations regarding confidential information generally should not be conducted on cellular phones, or in elevators, restrooms, restaurants, or other places where conversations might be overheard.

BARTLETT HOUSE, INC.
CONFIDENTIALITY AGREEMENT
Legal Provisions concerning confidentiality have been established on both State and Federal levels:
In the Federal Law, the legal provisions are included in the Social Security Act. The Social Security Act requires the state to provide safeguards which restrict the use of and disclosure of information concerning applicants and recipients directly connected with the administration of the assistance or service program being provided and to protect from public disclosure communications of an intimate and personal character made in confidence to state and local agencies.
The Public Welfare Law of West Virginia requires the Department to establish rules and regulations governing the custody, use and preservation of the records, papers, files and communications concerning applicants and recipients of services provided by the Department of a Human Services. These regulations include the use of locked files in which all records are to be kept at night and the manner in which old records are destroyed.
CASE RECORDS ARE TO BE KEPT IN A FILE WHEN NOT IN USE BY A VOLUNTEER OR EMPLOYEE AND ARE TO PLACED IN A LOCKED FILE AT THE END OF THE DAY. RECORDS ARE NOT TO REMAIN ON DESKS OVERNIGHT.
INFORMATION TO BE CONSIDERED CONFIDENTIAL:
The information that must be considered confidential by Department or Purchase Service Provider staff falls into two classes:
I -Lists of individuals assembled from agency files
2-Information pertaining to individual cases, recorded and unrecorded, from whom or about whom facts have been secured by staff.
All information concerning a recipient of services under contract with the Department must be held in the strictest of confidence unless a client gives written consent to such disclosure. The only exception to this policy is the right of the Department to request any information necessary for the responsible administration of the Purchase of Social Services Program. TIE Department of course, maintains the same level of confidentiality as is required on contractors.
Case material should be discussed only:
-in conference with the supervisor or director
-with another worker, counselor, case manager when that worker's cooperation is needed in the planning of a case situation
-in planned group meetings when the identifying data is changed so that the case names are not revealed
RELEASE OF INFORMATION
Written consent must be obtained for release of information. These releases would be specific, time limited, and a copy filed in the case record for documentation.
Please note:
In dealing with confidentiality we are only concerned about regulations which specify that we may not reveal information about the applicant/recipient without his/her specific permission, but we are also guided by social work principals such as the right the individual to make decisions about matters which directly affect him/her to retain control over his/her own life. We must keep in mind that the individual has the right to choose not 10 qualify for assistance or service rather than agree to releasing information about his/her situation.
Remember that confidentiality applies to any information about the individual applying for or receiving services. This means inquires, verbal and written response to inquiries, forms, medical/legal documents, recorded or unrecorded information obtained from the individual staff member or the Department or services provider.
Confidentiality is a compliance issue both the Title XX Purchase of Social Services and for the standards Homeless Shelter Programs.

BARTLETT HOUSE, INC.
PERSONNEL POLICIES AND PROCEDURES HANDBOOK
1.8 BUSINESS ETHICS AND CONDUCT
Effective Date: 06/27/2017 Revision Date: 04/01/2017
The successful business operation and reputation of Bartlett House, Inc. is built upon the principles of fair dealing and ethical conduct of our employees. Our reputation for integrity and excellence requires careful observance of the spirit and letter of all applicable laws and regulations, as well as a scrupulous regard for the highest standards of conduct and personal integrity.
Our continued success is dependent upon our community's trust and we are dedicated to preserving that trust. Employees owe a duty to Bartlett House Inc., our clients and funders to act in ways that will merit the continued trust and confidence of the public.
As an organization, Bartlett House, Inc. will comply with all applicable laws and regulations and we expect our directors, officers, employees and volunteers to conduct business in accordance with the letter, spirit, and intent of all relevant laws and to refrain from any illegal, dishonest, or unethical conduct.
Bartlett House, Inc. prohibits "dual relationships" with clients. The only relationship that staff should have with clients is one of a professional nature. Employees of Bartlett House, Inc. are not permitted to socialize, fraternize, live with, solicit services or any other relationship outside of the workplace. Your interaction with clients should begin when you punch in and should end when you punch out.
In general, you should find that using good judgment, based on high ethical principles, will guide you to act appropriately. If you are unsure about the proper course of action, you should discuss the matter openly with your supervisor. If necessary, you may also contact the Executive Director for advice and consultation.
It is the responsibility of every Bartlett House, Inc. employee to comply with our policy of business ethics and conduct. Disregarding or failing to comply with this standard of business ethics and conduct could lead to disciplinary action, up to and including termination of employment.

BARTLETT HOUSE, INC.
PERSONNEL POLICIES AND PROCEDURES HANDBOOK
CONFLICT OF INTEREST STATEMENT
PLEASE USE THE FOLLOWING DOCUMENT TO REPORT ANY REAL OR POTENTIAL CONFLICTS OF INTEREST WITHIN 24 HOURS, IF A CONFLICT ARISES.
The employees, volunteers, and board of directors of Bartlett House will not pursue actions that benefit themselves or others at the expense of the agency or that give the appearance of compromising the agency’s interests. This includes avoiding actual, potential, and perceived conflicts of interest.
Examples of such conflicts of interest include but are not limited to:
• Relatives or individuals with close personal relationships serving as directors and staff members. For purposes of this policy, relatives include, but are not necessarily limited to: husband, wife, son, daughter, mother, father, brother, sister, grandparent, grandchild, aunt, uncle, niece, nephew, father-in-law, mother-in-law, sister-in-law, and brother-in-law. This policy covers “natural” relatives as well as those occupying these positions by operation of law or circumstances.
• A supervisor with authority to hire, fire, and/or discipline relatives or individuals with close personal relationships.
• Directors whose clients are Bartlett House staff or clients.
• Directors who have a financial interest in any vendor doing business with Bartlett House or has a family member, friend, or business or professional associate doing business with Bartlett House.
I understand that the purposes of this policy is to protect the integrity of Bartlett House’s decision-making process, to enable our constituencies to have confidence in our integrity, and to protect the integrity and reputations of volunteers, staff and board members. Upon or before election, hiring or appointment, I will make a full written disclosure of interests, relationships, and holdings that could potentially result in a conflict of interest. This written disclosure well be kept on file and I will update it as appropriate.
In the course of meetings or activities, I will disclose any interests in a transaction or decision where I (including my business or other nonprofit affiliations), my family and/or my significant other, employer, or close associates will receive a benefit or gain. After disclosure, I understand that I will be asked to leave the room for the deliberations and will not vote on the question. In addition, I understand that I will need to offer my resignation as a board member, staff, or volunteer if my continual service as such results in a violation of this policy. I understand that this policy is meant for the benefit of Bartlett House and is to enhance the good judgment of all parties, and I will comply with it in spirit and letter.
I will report any interests, relationships and holdings which will or may be actual, potential, and/or perceived conflicts of interest AND complete a conflict of interest form, which my supervisor will provide to me immediately upon request, within 24 hours of identifying a conflict of interest.

By clicking 'I Agree' below, I am indicating that I agree to abide by the Bartlett Housing Solutions Conflict of Interest Policy.

BARTLETT HOUSING SOLUTIONS, INC.
PERSONNEL POLICIES AND PROCEDURES HANDBOOK
5.8 COMMUNICATION WITH THE MEDIA
Effective Date: 06/27/2017 Revision Date: 04/01/2017
Unless otherwise approved by the Board of Directors of Bartlett House, Inc., the only persons authorized to discuss matters with the news media, community relations groups, and/or city, county or state organizations are as follows:
• Executive Director/Chief Executive Officer (CEO)
These individuals are designated as an "Authorized Spokesperson." Anyone other than those authorized to speak on behalf of the organization are not to respond, under any circumstances, to inquiries from the news media, community relations groups, and/or city, county or state organizations unless specifically authorized to do so by an "Authorized Spokesperson"
Employees are to refer all media calls to an "Authorized Spokesperson". Please do not say you are not allowed to talk to a reporter or have to get permission to do so. Instead, tell the reporter: "Bartlett House, Inc. policy is to refer all media inquiries our Executive Director or Assistant Director. You can reach them at (telephone number)."
Whenever taking a call from the media, the same courtesy and professionalism in which we approach board members, clients, donors, co-workers, customers, etc. should be displayed toward the media. Please act quickly when approached by the media to ensure that the reporter's deadline is met. This is important because the way this call is handled may be the reporter's first impression of Bartlett House, Inc. and that first impression may end up in the story published or the news segment broadcast. In order to promote our image, it is important to respond quickly, courteously and professionally to all media calls. Please remember to contact an "Authorized Spokesperson" if and when you have been approached by the media.
Failure to follow this policy may result in disciplinary action up to and including termination.