Please complete this application form if you are interested in volunteering . Once you complete the form, click the Continue button at the bottom.


Name and address

Please complete the following information:



Demographic Information

It is used only to help us get a better idea of the demographic make-up of our volunteers. We also have to make sure that volunteers are over the age of 18.



Email Preferences

We like to keep volunteers informed by sending the following Messages:

Electronic Newsletter-is what we use for most information, including meetings, required training and deployment issue.

Training-for just training classes

Activation- this is used for an immediate activation, if SMS is down

Weather-for current weather warnings and watches, if the SMS is down.



Interests

Please list your interest:



Education


Employment Status

Are you working, retired or unemployed? This is just to get an idea of your availability.



Special Skills or Qualifications

Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or other activities.

If you opt out of Newsletter, you will not get most training and deployment notifications.



Previous Volunteer Experience

Summarize your previous volunteer experience.



Prior Convictions:

Other than driving, if yes, please explain:



Person to Notify in case of Emergency

Complete the following information:



Volunteer Service Agreement

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that As a volunteer for Independence, I agree to comply with the following:


1. To donate services in the capacity of Volunteer for the City of Independence Emergency Preparedness Division (EP) without expectation of current or future salary, wages, or benefits not otherwise specified.


2. That I am not considered an employee of EP for any purposes other than tort claims and injury compensation while performing the above described voluntary services.


3. That I will fully cooperate with EP and its agents in any investigation, lawsuit, arbitration, or any other legal or quasi-legal proceedings that arise from the matters covered by this agreement.


4. That if I am responsible for injuries to third parties or damages to their property while acting outside the scope of assigned volunteer duties and/or training, I may be held personally liable for any monetary damages a court may award to the injured party and subject to disciplinary actions through EP.


5. To notify EP supervision immediately of any incident that occurs or may occur within my knowledge, which gives rise to liability on the part of myself or to the City of Independence.


6. That all publications, films, slides, videos, artistic or similar endeavors, resulting from direct and specific volunteer services will become the property of EP, and as such, will be in the public domain and not subject to copyright laws.


7. That my volunteer services can be revoked pursuant to the Volunteer Disciplinary Procedures Policy. Upon notice of revocation of volunteer services, I shall return all equipment, media, and any other items belong to EP within 24 hours of revocation notification.


8. That I have not been convicted of or pleaded guilty to driving under the influence of alcohol, driving while ability impaired, or reckless driving during the past five years.


9. That if I am operating an automobile while performing my volunteer assignments and/or responsibilities that I agree to maintain a valid driver’s license. Upon request, I will provide EP with a copy of my driver’s license.


10. That I have not been convicted of a felony or any offense involving the sexual molestation or physical or sexual abuse or rape of a child; and that I have not been convicted of a crime of moral turpitude.


11. That I will not use, or authorize the use of, the name, emblem, endorsement, services or property of EP or any associated program for the benefit or advantage of myself or any person without the approval of Independence Emergency Preparedness.


12. That I will not use my participation as a volunteer to promote any partisan politics, religious matters, or positions on any issues.


13. That I will not accept, or seek on behalf of any person, any money or gifts offered because of my participation as a volunteer.


14. That under no circumstances will I speak publicly as a professional emergency responder or official of Independence Emergency Preparedness without specific permission or authorization granted by the Emergency Preparedness Manager and for specific purposes. I will direct all media or other individuals who are looking for comment to the designated City Public Information Officer.


15. That I will comply with this document anytime I am wearing identifiable apparel, logos, badges, etc.


16. That I have received, read, understand, and will adhere to the City of Independence Drug and Alcohol-Free Workplace Policy and agree to submit to random or pre-determined drug and/or alcohol screenings upon request.


17. To follow the supervision and direction of EP staff or designated volunteer leadership and to participate in any training required by EP to perform the voluntary services.


18. That I will act within the scope of my training. If I hold a medical license, I will act within the scope of my practice and training relevant to that license.


19. To report all emergencies to 911 prior to rendering any assistance.

• Exception: Volunteers with a medical license will stabilize the patient to the best of their ability within their scope of practice and training until emergency medical responders arrive. Medical volunteers will allow emergency medical responders to take control of the patient as soon as the responders arrive.


20. That when disasters strike, my first responsibility is to ensure my own safety and the safety of my family.


21. That I will adhere to the official EP Deployment policy.


22. That when responding for activation, I will bring or wear my personal safety equipment. For disaster situations, that includes sturdy shoes or boots and long pants.


23. That I will act within my physical and resource limitations when responding. Such limitation may be determined by, but not limited to available equipment, physical abilities, knowledge, hazards, etc.


24. That I will respect the authority of professional responders and take direction from them on scene.


25. That I will not carry or possess guns or other weapons while acting in my volunteer capacity.


26. That as a volunteer member of the City of Independence Emergency Preparedness Division (EP), I understand that I represent EP and its various units and organizations to other volunteer members, partner organizations, the public, and to those to whom we render services. For that reason, I understand that it is important to portray a positive and professional image at all times. This includes, but is not limited to:

a. Conducting myself appropriately and responsibly;

b. Treating others with respect and courtesy;

c. Avoiding inappropriate conduct that could jeopardize organizational effectiveness and respect for the organization.


I understand that failure to comply with the Volunteer Agreement and the policies referenced herein will result in disciplinary action in accordance with the EP Volunteer Disciplinary Procedures Policy. I certify that I have read this document

If I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.