Before completing this form, please read the "Confidentiality Policy" that was posted underneath the link to this form. Then please complete this application form if you are interested in volunteering with Bethesda Mission to complete court-ordered community service hours. Once you complete the form, click the Continue button at the bottom.


* = required


Contact Information


Emergency Contact

In the event of an emergency whom should we notify?



Employer

Please list your current or most recent employer:



References


Community Service Details

If you answer "yes" to any of these, please be sure to explain in detail in the box below.



Skills & Experience

In which areas do you feel you have moderate to excellent skill? We will do our best to consider volunteer opportunities that may fit your particular skill set.



Availability

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



I Agree

I understand and agree that submitting this application form does not automatically register me as a Bethesda Mission volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.


I certify that to the best of my knowledge and belief, all of the information I have provided on this application is true, correct, complete, and made in good faith. I understand that a false statement on any part of this application may be the basis for disqualifying me as a volunteer at Bethesda Mission, or for discontinuing my services after I begin volunteering.


I consent to the release of information by employers, law enforcement agencies and other individuals and organizations to designated representatives of Bethesda Mission.


I acknowledge that I RECEIVED AND READ the Confidentiality Policy and understand or have sought understanding of its content, and I recognize that it is my responsibility to abide by all rules contained in the policy.


As a volunteer, I may have access to confidential and private information in various forms, such as written, electronic, oral, overheard, or observed or any other source, and I am required to maintain this information in a confidential manner. The unauthorized access to, modification, deletion or disclosure of confidential or private information may compromise the integrity of the Mission's written or electronic records and violates individual rights of confidentiality and privacy. I further understand that Bethesda Mission will not tolerate unauthorized disclosure of confidential or private information and will not hesitate to dismiss any volunteer who violates this policy.


I acknowledge and agree to the requirements of the Confidentiality Policy.