Good Samaritan Services | Volunteer Application

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Parental Consent *If you are minor please have parent fill out the box. By checking YES, you agree to parental consent. Parental Consent *If you are minor please have parent fill out the box. By checking YES, you agree to parental consent.

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IF MINOR - please list parent/guardian name, address, and phone number. IF MINOR - please list parent/guardian name, address, and phone number.

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Review the information below

Volunteering with Good Samaritan Services is an intentional ministry supporting individuals and families experiencing or at risk of homelessness. Over the course of your time as a volunteer, you will play a significant role in the lives of the people you are assisting. Since this ministry is based on relationships, we encourage all volunteers to exhibit emotional, social, and spiritual maturity.

Promise of Confidentiality:

I acknowledge that in my volunteer capacity with Good Samaritan Services I may have access to confidential information regarding the individual or family, which I may be serving. In connection to such access, I pledge myself to hold all information gained about the person (s) in confidence and protect their right to privacy.

In signing this pledge of confidentiality, I will commit myself to the confidentiality requested by Good Samaritan Services and the person(s) involved. If at any point I question whether it would be helpful or appropriate to give such information outside the volunteer experience, I will approach Good Samaritan Services Staff or the person (s) involved in Good Samaritan Services.

I understand that the participant (s) being served may have signed a "release of confidentiality" between the volunteer(s) and Good Samaritan Service, and that Good Samaritan Service will not share any information with the volunteer which the participant has requested to be held in confidence.

Use of images/videos/sound recordings/written interviews:

To protect confidential information please do not share images/videos/sound recordings or written interviews in any manner unless you receive consent from the staff of Good Samaritan Services.

To keep our community and supporters informed about the good work of Good Samaritan Services we would like to share images of your volunteer service on social media, newsletters, our website, and other printed and online material. If you do not want us to publicize your volunteer service at Good Sam please let us know.

As a volunteer, I acknowledge that:

– Part of my role as a volunteer includes modeling positive personal and family interaction.

– I have never been investigated, charged, or convicted of child abuse, including sexual abuse. I will also give signed permission to Good Samaritan Service to request:

· A PA Request for Criminal Record Check

· A PA Child Abuse History Clearance

· A FBI clearance may be required if I relocated to PA in the last 12 months

In the event that there is any incriminating information on these forms, I understand Good Samaritan Service has permission to ask me not to be a volunteer.

– If I volunteer to care for a child in Good Samaritan Services’ program, I will provide a safe and secure environment for him or her.

– If I do not have liability coverage on my vehicle, I will not provide transportation for this family.

WHISTLEBLOWER POLICY

Introduction:

The Sarbanes-Oxley Act amended the federal criminal code to create or enhance penalties for retaliating against whistleblowers while a federal investigation is underway. These changes to the criminal code apply to all business entities, possibly including nonprofit organizations, their board members and employees. Therefore, adopting policies and procedures for the protection of whistleblowers is advisable.

Policy:

GOOD SAMARITAN SERVICES is committed to facilitating open and honest communications relevant to its governance, finances, and compliance with all applicable laws and regulations. GOOD SAMARITAN SERVICES requires directors, other volunteers, and employees to observe high standards of business and personal ethics in the conduct of their duties and responsibilities. Employees and representatives of the organization must practice honesty and integrity in fulfilling their responsibilities and comply with all applicable laws and regulations.

This whistleblower policy (“the Policy”) reflects the practices and principles of behavior that support this commitment. It is important that GOOD SAMARITAN SERVICES be apprised about unlawful or improper workplace behavior including, but not limited to, any of the following conduct:

· theft;

· financial reporting which is fraudulent, intentionally misleading or negligent in any manner;

· improper or undocumented financial transactions;

· forgery or alteration of documents;

· unauthorized alteration or manipulation of computer files;

· improper destruction of records;

· improper use of GOOD SAMARITAN SERVICES assets, including, but not limited to its funds, supplies, intellectual property and other assets;

· improper access and or use of confidential donor information;

· authorizing or receiving compensation for goods not received or services not performed;

· violations of GOOD SAMARITAN SERVICES’s conflict-of-interest policy;

· any other improper occurrence regarding cash, financial procedures, or reporting;

· any abuse of or discrimination against a GOOD SAMARITAN SERVICES employee, client, vendor or person connected with a GOOD SAMARITAN SERVICES member; and

· a failure by GOOD SAMARITAN SERVICES to provide reasonable accommodation for disability or religious belief.

We request the assistance of every director, other volunteer and employee who has a reasonable belief or suspicion about any improper transaction. GOOD SAMARITAN SERVICES values this input and each director, volunteer and employee should feel free to raise issues of concern, in good faith, without fear of retaliation. Directors, volunteers and employees will not be disciplined, demoted, lose their jobs, or be retaliated against for asking questions or voicing concerns about conduct of this sort. While GOOD SAMARITAN SERVICES has separate policies which cover harassment and employment discrimination, this Whistleblower Policy applies to these situations to encourage the reporting of such wrongful actions against GOOD SAMARITAN

SERVICES’s interest. Employees and other interested persons are encouraged to report any such improprieties without fear of retaliation or intimidation.

GOOD SAMARITAN SERVICES will investigate any possible fraudulent or dishonest use or misuse of GOOD SAMARITAN SERVICES’s resources, or abuse, discrimination or a failure to provide reasonable accommodation, by management, staff, or volunteers. GOOD SAMARITAN SERVICES will take appropriate action against anyone found to have engaged in fraudulent, dishonest, abusive or discriminatory conduct, including disciplinary action by GOOD SAMARITAN SERVICES, or civil or criminal prosecution when warranted.

Therefore, all members of GOOD SAMARITAN SERVICES staff, directors and other volunteers are encouraged to report possible fraudulent, abusive, discriminatory, or dishonest conduct (i.e., to act as a “whistleblower”), pursuant to the procedures set forth below.

Reporting Responsibility:

Each director, volunteer, and employee of GOOD SAMARITAN SERVICES has an obligation to report in accordance with this Whistleblower Policy (a) questionable or improper accounting, financial or auditing matters, and (b) violations and suspected violations of GOOD SAMARITAN SERVICES’s policies or any unlawful or improper workplace conduct (hereinafter collectively referred to as “Concerns”).

Authority of Audit Committee:

All reported Concerns will be forwarded to the Audit Committee in accordance with the procedures set forth herein. The Audit Committee shall be responsible for investigating, and making appropriate recommendations to the Board of Directors, with respect to all reported Concerns.

No Retaliation:

This Whistleblower Policy is intended to encourage and enable directors, volunteers, and employees to raise Concerns within the Organization for investigation and appropriate action. With this goal in mind, no director, volunteer, or employee who, in good faith, reports a Concern shall be subject to retaliation or, in the case of an employee, adverse employment consequences. Moreover, a volunteer or employee who retaliates against someone who has reported a Concern in good faith is subject to discipline up to and including dismissal from the volunteer position or termination of employment.

I agree with the terms and conditions

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