Date of Birth

Date of Birth (DOB): Please use numbers only, no spaces or dashes

Email

Email Address

Preferred Location

Have you ever been convicted of a felony

If yes, please explain the felony below

I certify that all statements made by me on this application are true and correct to the best of my knowledge and that I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand and agree that any misrepresentations or omission of facts can exclude my being considered for volunteer services or after my service begins may be cause for termination. (*)

I understand that my involvement as a volunteer with Outsiders Inn and the Severe Weather Shelter locations is contingent upon a clean criminal background check. (*)

I will perform services as a Outsiders Inn Severe Weather Shelter volunteer without compensation, and in performing such services I acknowledge that I am not acting as an employee of Outsiders Inn or Severe Weather Shelter locations. (*)

I understand that I may have access to, or work with information considered confidential regarding shelter guests. I agree to hold all such information in complete confidence both during and following my volunteer period with Outsiders Inn and the Severe Weather Shelter locations. (*)

I understand that my participation is strictly on a volunteer basis and that there will be no insurance provided against bodily harm. I also understand that volunteer positions are not covered under Worker’s Compensation Insurance. I agree to hold harmless entity known as Outsiders Inn serving as a volunteer. (*)

I understand host locations will have access to my name to comply with their policy. (*)

By checking this box I certify under the penalty of perjury all statements above are true and acknowledge background checks are issued for all Outsiders Inn Severe Weather Shelter volunteers through the Washington State Patrol WATCH. (*)

Do you authorize Outsiders Inn to perform a background check? (*)

Signature: (*) Please type your full name as your 'signature".

Date Signed (*)

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