Please complete this application form if you are interested in becoming a Jewish Family Service Agency volunteer. Once you complete the form, click the Continue button at the bottom.


Name and address


How Did you hear about JFSA's Program?


Preferences

Please select any volunteer position you are interested in



Availability

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



Senior Companion and Choose Home Drivers

Drivers must have a vehicle and clean Motor Vehicle Record, which will be pulled.



Criminal History

Before being accepted as an AmeriCorps Seniors volunteer, you must satisfactorily pass a criminal history background check, performed in accordance with the National Service Criminal History Check requirements.


HAVE YOU EVER BEEN ARRESTED, CHARGED, CONVICTED, PLED NO CONTEST, OR PLED GUILTY TO A FELONY OR MISDEMEANOR. HAVE YOU HAD ANY INTERACTION WITH THE POLICE? EVEN IF YOU THINK AN INTERACTION MAY NOT COME UP ON A BACKGROUND CHECK, PLEASE INCLUDE THE DETAILS. IF YOU DO NOT DISCLOSE AND AN INCIDENT SHOWS UP ON THE REPORT, YOU WILL BE DISQUALIFIED AS A VOLUNTEER. (PLEASE NOTE: A FALSE STATEMENT MADE IN CONNECTION WITH THIS QUESTION DISQUALIFIES THE PERSON TO SERVE IN OUR PROGRAM)



Benefits of Being an AmeriCorps Seniors Volunteer

As a JFSA AmeriCorps Seniors volunteer, you will be covered by supplemental accident and personal liability insurance while performing volunteer duties. This coverage is automatic and free of cost to you if you are an active, enrolled member of Foster Grandparent (FGP)/Senior Companion (SCP)/Choose Home (CHP).

FGP/SCP/CHP provides reimbursement for travel between home and volunteer site; if you are a driver, FGP/ SCP/CHP will reimburse your mileage, as funds allow. The volunteer must maintain Auto Insurance and a current Nevada Driver’s License to be eligible for reimbursement; evidence of coverage must be maintained in the volunteer’s file.

FGP/SCP/CHP volunteers who meet AmeriCorps Seniors income qualifications can receive a modest stipend for hours served. The stipend is not a wage, or payment for service; volunteers are not employees of JFSA, Clark County School District (CCSD), the AmeriCorps Seniors program, nor the federal government.



Special Accommodations

Do you require any special accommodations or have physical or medical considerations that may impact a volunteer assignment?



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.



Social Media/Photo Release

As a participant in JFSA’s volunteer program, I understand that photographs and/or videos may be taken in an effort to promote the organization to the general public. I agree to allow JFSA’s unrestricted use of photographs taken of me, if applicable, in the course of participation in activities sponsored by JFSA. JFSA will have total ownership of these materials, and the right to edit and use for purposes of program promotion, advertising, or public relations. I understand that JFSA intends to use such photographs only in connection with official JFSA publications and documents. I agree to the Photo and Social Media Consent Statement.



Emergency Contact


Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.



Certifications

I acknowledge that I have read and understand the following statements:

• I hereby state that I am 55 years of age or older and offer my services as a volunteer for the JFSA Foster Grandparent/Senior Companion/Choose Home Program. I understand that I am not an employee of the FGP/SCP/CHP Project, the sponsor (JFSA), the volunteer station or the Federal Government.

• I understand that this is an application for, and not a commitment or promise of a volunteer position.

• I understand that in my capacity as an FGP/SCP/CHP volunteer I may encounter confidential information. I agree to protect this information to the best of my ability and not to disclose it during or after my service as a volunteer has ended.

• I understand that if I use my personal automobile in my volunteer service, I will arrange to keep in effect automobile liability insurance equal to or greater than the minimum requirements of the state of Nevada. I will also keep in effect a valid Nevada driver's license. Mileage will not be reimbursed if auto insurance or driver’s license has lapsed.

• I understand that if the Background Check reveals convictions I have not disclosed above or the use of multiple or conflicting items of personal identifying information (such as social security number, date of birth, place of birth, etc.) I may not be accepted into the Program, and if already serving in some capacity, my participation may be terminated.

• I certify that the information contained in this enrollment form is true and correct; and I understand that if I falsified this information, I can be immediately dismissed.

• I understand that my volunteer position is contingent upon successfully completing a background check.