Volunteer Application (3)
- 1. 139 Main Street Cambridge, MA 02142-1530 of Massachusetts Bay (617) 274-5200 phone (617) 274-5250 fax Volunteer Application General Information Last Name First Middle Initial Street Address City State Zip Code Home Phone Work Phone Other Phone ( ) ( ) ( ) Home E-Mail Work E-Mail Emergency Contact Relationship to You Address Phone ( ) Are you over 18 years old? No Yes Are you licensed to operate a motor vehicle in Massachusetts? No Yes Gender (Optional) Ethnicity (Optional) Veteran (Optional) Date of Birth (Optional) American Indian Native Hawaiian/Other Pacific Male Female Asian Two or more races No Yes African American Unspecified Hispanic or Latino White Red Cross Affiliation Are you now or have you ever been employed by the American Red Cross? No Yes If yes, please list the location, position/responsibilities, and dates below: Are you now or have you ever served as a Red Cross volunteer staff member? No Yes If yes, please list the location, position/responsibilities, and dates below: Professional Licenses (e.g. RN, EMT, Mental Health, etc.) License Type No. State Expiration Date License Type No. State Expiration Date Specialized Skills List any computer software with which you are proficient: List any second languages skills you possess Fluency (including sign language): Written Spoken Excellent Good Fair Excellent Good Fair Excellent Good Fair Excellent Good Fair Excellent Good Fair Excellent Good Fair Please list any other relevant skills: Record of Conviction Have you been convicted of a crime other than a minor traffic offense within the last 5 years (including during Military Service)? No Yes If yes, please list below:
- 2. Volunteer Application (continued) Education (please feel free to attach a resume in lieu of completing this section) High School Name City State Diploma Date College Name City State Degree / Major / Date Other City State Degree or Certification / Date Experience (please feel free to attach a resume in lieu of completing this section) Employer Name Beginning Date Ending Date Position(s) Held Phone ( ) Summary of Duties: Employer Name Beginning Date Ending Date Position(s) Held Phone ( ) Summary of Duties: Employer Name Beginning Date Ending Date Position(s) Held Phone ( ) Summary of Duties: References (please list non-relatives who know your qualifications or experience) Name Relationship Phone ( ) Name Relationship Phone ( ) Name Relationship Phone ( ) Volunteer Interest and Availability (please check areas that interest you and indicate times you are available) Interest Availability Disaster Relief Services Administrative/Clerical Mon. morning Mon. midday Mon. evening Sat. AM Health and Safety Services Fundraising Services Tues. morning Tues. midday Tues. evening Sat. PM Food and Nutrition Services Public Relations Support Wed. morning Wed. midday Wed. evening Sun. AM Youth Services Sales and Marketing Thurs. morning Thurs. midday Thurs. evening Sun. PM International Services Data Entry Support Fri. morning Fri. midday Fri. evening Consent for Reference and Background Check I do hereby give the American Red Cross of Massachusetts Bay (ARCMB) permission to inquire into my education, references, driving record, employment, volunteer history, or police record. I further give permission to the holder of any such records to release the same to ARCMB. I hereby hold ARCMB harmless of any liability, whether civil or criminal, that may arise as a result of the release of this information about me. I further hold harmless any individual, agency, business, or corporation that provides information or documents to ARCMB. I understand that ARCMB will use this information as part of its verification of my volunteer application. I further understand that as a Red Cross Volunteer, I am not paid for my services. Signature of Applicant Date Signature of Parent/Guardian Date (if applicant is under 18)
- 3. 139 Main Street Cambridge, MA 02142-1530 of Massachusetts Bay (617) 274-5200 phone (617) 274-5250 fax CODE OF BUSINESS ETHICS AND CONDUCT The American Red Cross is a not-for-profit charitable organization dedicated to providing services to those in need. The Red Cross has traditionally demanded and received the highest ethical performance from its employees and volunteers. In an effort to maintain the high standard of conduct expected and deserved by the American public and to enable the organization to continue to offer its services, the American Red Cross operates under the Code of Business Ethics and Conduct outlined below. All employees and volunteers are required to sign the Code of Business Ethics and Conduct form certifying that, in delivering Red Cross services and in all other Red Cross activities, they shall meet the following standards of conduct: • Compliance Requirements. All employees and volunteers are required to comply with applicable federal, state and local laws and regulations and with American Red Cross corporate policies and regulations. • Actions Prohibited by the Code of Business Ethics and Conduct. No employee or volunteer shall engage in the following actions: a. Personal Use. Authorize the use of or use for the benefit or advantage of any person, the name, emblem, endorsement, services or property of the American Red Cross, except in conformance with American Red Cross policy. b. Financial Advantage. Accept or seek on behalf of or any other person, any financial advantage or gain of other than nominal value offered as a result of the employee’s or volunteer’s affiliation with the American Red Cross. c. Red Cross Affiliation. Publicly use any American Red Cross affiliation in connection with the promotion of partisan politics, religious matters or positions on any issue not in conformity with the official position of the American Red Cross. d. Confidentiality. Disclose any confidential American Red Cross information that is available solely as a result of the employee’s or volunteer's affiliation with the American Red Cross to any person not authorized to receive such information, or use to the disadvantage of the American Red Cross any such confidential information, without the express authorization of the American Red Cross. e. Improper Influence. Knowingly take any action or make any statement intended to influence the conduct of the American Red Cross in such a way as to confer any financial benefit on any person, corporation or entity in which the individual has a significant interest or affiliation. f. Conflict of Interest. Operate or act in a manner that creates a conflict or appears to create a conflict with the interests of the American Red Cross and any organization in which the individual has a personal, business or financial interest. In the event there is a conflict, the American Red Cross has a structured conflict of interest process. First, the individual shall disclose such conflict of interest to the chairman of the board or the chief executive officer of the individual’s Red Cross unit or the general counsel of the American Red Cross, as applicable. Next, a decision will be made about the conflict of interest, and, where required, the individual may be required to recuse or absent himself or herself during deliberations, decisions and/or voting in connection with the matter. g. Retaliation. Retaliate against any employee or volunteer who seeks advice from, raises a concern with or makes a complaint to a supervisor or other member of management, the ombudsman, the Concern Connection Line, the Biomedical Regulatory Hotline or any other whistleblower program, about fraud, waste, abuse, policy violations, discrimination, illegal conduct, unethical conduct, unsafe conduct or any other misconduct by the organization, its employees or volunteers. h. Contrary to the Best Interest of the Red Cross. Operate or act in any manner that is contrary to the best interest of the American Red Cross. • Ombudsman Program – Informal Dispute Resolution. The American Red Cross has an organizational ombudsman designated as the neutral or impartial dispute resolution practitioner whose major function is to provide confidential
- 4. Code of Business Ethics and Conduct (continued) and informal assistance to the many constituents with concerns or complaints about the Red Cross. The constituents who seek the ombudsman’s services are internal stakeholders, such as employees and volunteers, and external stakeholders, such as Red Cross clients, donors, suppliers, vendors and the public at large. The ombudsman provides a voluntary, confidential and informal process to facilitate fair and equitable resolutions and explore a range of alternatives or options to resolve the problems. If a formal investigation is what the individual seeks, referrals to the whistleblower hotlines may be appropriate. • Investigations, Compliance and Ethics – Formal Dispute Resolution. Distinguishing from the actions of the ombudsman, the Office of the General Counsel and the Office of Investigations, Compliance and Ethics (IC&E) conduct formal investigations into allegations of fraud, waste, abuse, Red Cross policy violations, illegal or unethical conduct or other improprieties regarding the Red Cross. Usually, the allegations arise from whistleblower complaints of Red Cross employees and volunteers seeking formal review or investigations of their allegations of wrongdoing. • Whistleblower Hotline Programs. The American Red Cross encourages open communications. All employees and volunteers are encouraged to bring any concerns they have regarding the organization or its employees and volunteers to their direct supervisor. If individuals seek an informal and confidential resolution, the ombudsman may be the appropriate choice. If a formal IC&E investigation is sought, the hotlines described below are the appropriate choice. If an employee or volunteer suspects or knows about misappropriation, fraud, waste, abuse, Red Cross policy violations, illegal or unethical conduct, unsafe conduct or any other misconduct by the organization or its employees or volunteers, that individual should alert his or her supervisor or other member of local management. In those cases where an employee or volunteer is not comfortable telling his or her supervisor or local management, the employee or volunteer may contact the Concern Connection Line at 1-888-309-9679. For concerns about the collection, manufacturing, processing, distribution or utilization of blood or blood components (e.g., violations of FDA or OSHA regulations, falsification, quality failures, training, Biomedical Services computer and equipment issues), an employee or volunteer who is not comfortable with contacting his or her supervisor or local management may contact the Biomedical Regulatory Hotline at 1-800-741-4738. CERTIFICATION OF COMMITMENT TO THE CODE OF BUSINESS ETHICS AND CONDUCT I, ______________________________________________, certify that I have read and understand the Code of Business Ethics and Conduct of the American Red Cross and agree to comply with it, as well as applicable laws that impact the organization, at all times. I affirm that, except as listed below, I have no personal, business or financial interest that conflicts, or appears to conflict, with the best interests of the American Red Cross. I agree to discuss any conflicts listed below with the chairman of the board or the chief executive officer of my unit or the general counsel of the American Red Cross and to refrain from participating in any discussions, deliberations, decisions and/or voting related to the matter presenting the conflict until such time as it is determined by the Red Cross that the conflict is mitigated or otherwise resolved. Describe any potential conflicts: ______________________________________________________________________________ _________________________________________________________________________________ At any time during the term of my affiliation with the American Red Cross, should an actual or potential conflict of interest arise between my personal, business or financial interests and the interests of the Red Cross, I agree to: 1. Disclose promptly the actual or potential conflict to the chairman of the board or the chief executive officer of my Red Cross unit or the general counsel of the American Red Cross; and 2. Until the Red Cross approves actions to mitigate or otherwise resolve the conflict, refrain from participating in any discussions, deliberations, decisions and/or voting related to the conflict of interest. Signature: ____________________________________________ Date: _______________________ Print Name: __________________________________________
- 5. 139 Main Street Cambridge, MA 02142-1530 of Massachusetts Bay (617) 274-5200 phone (617) 274-5250 fax CONFIDENTIAL INFORMATION AND INTELLECTUAL PROPERTY AGREEMENT For All Volunteers This Confidential Information and Intellectual Property Agreement (“Agreement”) is made as of the date of signature below (“Effective Date”), by and between THE AMERICAN NATIONAL RED CROSS, including all chartered units (“Red Cross”), and the undersigned (“I,” “me” or “my”). Reasons for Agreement I desire to volunteer or to continue to volunteer with the Red Cross. I acknowledge that I may, in the course of my service to the Red Cross (“Volunteer Service”), have access to or create (alone or with others) confidential and/or proprietary information and intellectual property that is of value to Red Cross. I understand that this makes my position one of trust and confidence. I understand Red Cross’ need to limit disclosure and use of confidential and/or proprietary information and intellectual property. I understand that all restrictions are for the purpose of enabling Red Cross to fulfill its humanitarian mission, to maintain donors, customers and clients, to develop and maintain new or unique products and processes, to protect the integrity and future of Red Cross and to protect the employment and volunteer opportunities of the Red Cross. THEREFORE, I agree to the following: 1. Definitions. “Confidential Information” shall include but not be limited to: I. Information relating to Red Cross’ financial, regulatory, personnel or operational matters, II. Information relating to Red Cross clients, customers, beneficiaries, suppliers, donors (blood and financial), employees, volunteers, sponsors or business associates and partners, III. Trade secrets, know-how, inventions, discoveries, techniques, processes, methods, formulae, ideas, technical data and specifications, testing methods, research and development activities, computer programs and designs, IV. Contracts, product plans, sales and marketing plans, business plans, and V. All information not generally known outside of Red Cross regarding Red Cross and its business, regardless of whether such information is in written, oral, electronic, digital or other form and regardless of whether the information originates from Red Cross or Red Cross’ agents. “Intellectual Property” shall include but not be limited to: I. All inventions, discoveries, techniques, processes, methods, formulae, ideas, technical data and specifications, testing methods, research and development activities, computer programs and designs (including improvements and enhancements and regardless of patentability), II. Trade secrets and know-how, III. All copyrightable material that is conceived, developed, or made by me, alone or with others, IV. Trademarks and service marks, and V. All other intellectual property. Intellectual Property shall include any intellectual property created by me: (a) In the course of Volunteer Service or using Red Cross time, equipment, information or materials, and (b) Within one (1) year after termination of Volunteer Service and relating directly to work done during Volunteer Service. Intellectual Property may be in any form, including but not limited to written, oral, electronic, digital or other form.
- 6. Confidential Information and Intellectual Property Agreement (continued) 2. Obligation of Confidentiality. Except as may be required for the performance of my duties during Volunteer Service, or unless specifically authorized in writing by Red Cross, I shall not use or disclose, for my or for others’ benefit, either during or after Volunteer Service, any Confidential Information. 3. Disclosure and Ownership of Intellectual Property. I (i) shall promptly and fully disclose to Red Cross any and all Intellectual Property, (ii) agree that all Intellectual Property shall be owned by Red Cross, (iii) agree to and do hereby assign, transfer and convey to Red Cross the entire right, title and interest in and to all Intellectual Property, (iv) will execute and deliver any and all documents, take all actions and render any and all assistance reasonably requested by Red Cross, during or at any time after Volunteer Service, to establish Red Cross’ ownership of, or to enable Red Cross to obtain patents to or register copyrights of, any Intellectual Property, and (v) acknowledge that all Intellectual Property that is copyrightable subject matter and that qualifies as a "work made for hire" shall be automatically owned by Red Cross. In the event Red Cross is unable for any reason whatsoever to secure my signature to any document required to apply for or execute any patent, copyright, or other applications with respect to Intellectual Property, I hereby irrevocably appoint Red Cross and its authorized officers and agents as my agents and attorneys-in-fact to execute and file any such application and to do all other acts to further the prosecution and issuance of patents, copyrights, or other rights with respect to Intellectual Property with the same legal force and effect as if executed by me. As a reminder, Intellectual Property shall only include intellectual property created by me (y) in the course of Volunteer Service or using Red Cross time, equipment, information or materials, and (z) within one (1) year after termination of Volunteer Service and relating directly to work done during Volunteer Service. 4. Ownership and Return of Material. All materials, including but not limited to business information, files, research, records, memoranda, books, lists, computer disks, hardware, software, cell phones and other wireless devices, documents, drawings, models, apparatus, sketches, designs and any other embodiment of Confidential Information or Intellectual Property received by me during Volunteer Service, and any tangible embodiments of such materials created by me, alone or with others, whether confidential or not, are the property of Red Cross. I shall return to Red Cross all such materials, including copies thereof, in my possession or under my control upon termination of Volunteer Service for whatever reason or upon the request of Red Cross. The return of such materials shall take place within twenty-four (24) hours of notice of termination or upon request of Red Cross, whichever comes first. 5. Survival of Obligations and Enforcement. The obligations that I have under this Agreement shall survive the termination of Volunteer Service, regardless of the reasons or method of termination. I agree that Red Cross shall be entitled to recover from me all attorneys’ fees incurred in enforcing Red Cross’ rights under this Agreement. I represent that the above restrictions are necessary to protect Red Cross’ legitimate interests, and that these restrictions will not prevent me from earning a livelihood. VOLUNTEER _______________________________ _______________________________ Signature Volunteer ID Number _______________________________ _______________________________ Printed Name Department or Division _______________________________ Title