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					                                                               Snohomish County Chapter
                                                                   2530 Lombard Avenue
                                                                       Everett, WA 98201
                                                                       Ph: (425) 252.4103
                                                                      Fax: (425) 258-1599




Hi,

Thank you very much for your interest in becoming a Red Cross volunteer. It is
an interesting and fun activity with its own special set of rewards.

There are a number of us Volunteer Coordinators here so if you have any
questions you can email us or call us directly at 425-740-2327. That will connect
you with whichever of us is on duty: Diana, Christine or Glenna.

We appreciate your desire to be a part of the Red Cross organization. We
understand the spirit and effort of volunteerism, so we truly hope that you will
find it rewarding and satisfying.

I am attaching copies of the required paperwork. Please fill in completely and
return all to us to the attention of “Volunteer Coordinator” at the Red Cross
address listed below.

Please sign and date the Confidentiality Agreement and we will complete the rest
of the information on the form as it becomes known.

As soon as we receive replies, you will be contacted in order to schedule the next
steps and your application process will continue to move forward.

Two references are requested. Please ask your references to return the attached
forms to us directly to the Volunteer Coordinators Office at the address listed
below.

Thank you for your interest and your spirit of volunteering.



American Red Cross
Volunteer Coordinators Office
Snohomish County Chapter
2530 Lombard Avenue
Everett, WA 98201
425-740-2327



                   http://www.snohomish county.redcross.org                      page 1 of 12
                                                                                                        Snohomish County Chapter
                                                                                                            2530 Lombard Avenue
                                                                                                                Everett, WA 98201
                                                                                                                Ph: (425) 252.4103
                                                                                                               Fax: (425) 258-1599


                                                   Volunteer Application
                                                                                                         Date:
                                     Name
                                                                                          Birth Date:

           last                            first                                  M.I.
                                                                                          Home phone:
                                                                                          Cell phone:
Address:                                                                                  Work phone:
                                      street
                                                                                          Email:


City, State, Zip:


Employer / School:                                          Occupation:                               Veteran:                    Yes           No

Gender:    F           M                   Marital Status (optional):                                   If Yes:      Pre or     Post-Vietnam-Era

Your driver’s license number is?                                        State?                              Expiration date?

Your highest level of education?                                        Your major field of study?

Professional licenses or certifications?                                            Volunteered at any Red Cross before? Yes                  No


Does your employer have a matching gift program for your volunteer time?                  Yes               No             Don’t know

Are you willing to make a commitment of six (6) months or longer?                   Yes            No

How did you learn about this volunteer program?


Why are you interested in volunteering?



Is your application for a school, an internship or any “for-credit” activity?             Yes                 No


What previous volunteer experience do you have with organizations including the American Red Cross?



Your current and previous work experience includes:



Have you been convicted of any criminal activity within the past seven (7) years?                  Yes              No

If yes, please explain the circumstances:
                                                               This will not necessarily keep you from becoming a volunteer.



I am available for volunteering:       Mornings             Afternoons              Evenings                Weekends

On days:          Monday      Tuesday              Wednesday               Thursday                Friday            Saturday             Sunday




                                        http://www.snohomish county.redcross.org                                                        page 2 of 12
                                                                                                  Snohomish County Chapter
                                                                                                      2530 Lombard Avenue
                                                                                                          Everett, WA 98201
                                                                                                          Ph: (425) 252.4103
                                                                                                         Fax: (425) 258-1599

   Please place a check mark beside any category of skills you possess:
         accounting                                      cpr / first aid instructor                       personnel interviewer
         administrative support                          data entry                                       office support
         baby sitting/baby sitting instructor            disaster action team                             phones
         budgeting                                       disaster mental health                           procurement
         casework                                        emergency phone response                         public presentations
         community education (disaster)                  facilities / maintenance                         speakers bureau
         community education (general)                   fundraising / public relations                   staff training
         computer programming                            human resources                                  translator ( language)
         community disaster education                    HIV / AIDS awareness instructor                  volunteer coordinator
         community service supervisor                    military family support                          word processing
         courier / driver                                misc’ short term project support                 writing / editing
         other: indicate other skills that might be of service to the Red Cross:

   Please prioritize your categories of personal interest in volunteering (#1 being your highest, #2 and so on, as many as you wish)
         accounting                                       cpr / first aid instructor                       personnel interviewer
         administrative support                           data entry                                       office support
         baby sitting/baby sitting instructor             disaster action team                             phones
         budgeting                                        disaster mental health                           procurement
         casework                                         emergency phone response                         public presentations
         community education (disaster)                   facilities / maintenance                         speakers bureau
         community education (general)                    fundraising / public relations                   staff training
         computer programming                             human resources                                  translator ( language)
         community disaster education                     HIV / AIDS awareness instructor                  volunteer coordinator
         community service supervisor                     military family support                          word processing
         courier / driver                                 misc’ short term project support                 writing / editing

   Aside from your regular volunteer placement are you willing to help with special projects? Yes                           No
   Languages spoken:

   Emergency Contact #1:                                                  Relationship:
   Home Phone: (            )                                             Cell Phone: (       )
   Emergency Contact #2:                                                  Relationship:

   Home Phone: (            )                                             Cell Phone: (       )

   The above information is submitted voluntarily and to the best of my knowledge is true and factual. I understand
   and consent that this information will be used for Red Cross purposes only and I realize that as a Red Cross
   volunteer I will not be paid for my service.
   Signature:                                                  Date:
   Signature of parent if under 18:
                                                           Optional and voluntary:
The following information is requested by United Way and the American Red Cross Headquarters for statistical purposes only:
Ethnicity:       Cambodian, Hmong, kmer, Kmu, Laotian, ,Mien Vietnamese____                Chinese ___         Filipino ___       Japanese ____
Korean ____         Pacific Islander ____     African American ____      Hispanic, Latino ____                 Caucasian ____



                                        http://www.snohomish county.redcross.org                                                  page 3 of 12
                                                                                           Snohomish County Chapter
                                                                                               2530 Lombard Avenue
                                                                                                   Everett, WA 98201
                                                                                                   Ph: (425) 252.4103
                                                                                                  Fax: (425) 258-1599

Native American or Alaskan native ____       Eastern European ____   Middle Eastern ____   Other or multi-racial ____ Not known ____

                                              On-Line Segments

       o Background Checks

             Go to: www.mybackgroundcheck.com.

             In the lower right hand corner, click the box labeled American Red
             Cross.

             Please initiate the background check within 48 hours of attending
             orientation.

             If you do not have internet access, please let the volunteer
             coordinator know and (s)he will make other arrangements for you.

             You will hear back from your supervisor once the background
             check has been completed.


       o Introduction to Disaster Services

             Go to: www.RedCross.org/flash/course01_v01.

             Complete the on-line course.

             At the end of the course, print out the final page and mail or bring
             it to the Chapter to be placed in your training records.

   .



                                         http://www.snohomish county.redcross.org                                      page 4 of 12
                                                                        Snohomish County Chapter
                                                                            2530 Lombard Avenue
                                                                                Everett, WA 98201
                                                                                Ph: (425) 252.4103
                                                                               Fax: (425) 258-1599



                                      American Red Cross
                                       Code of Conduct

                              Note: Retain this form for your records.


All volunteers and employees of the American Red Cross, in delivering Red Cross services and in all
other Red Cross activities, shall meet the following standards of conduct:

No volunteer or employee shall:

a. 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. Accept or seek on behalf of any person, any financial advantage or gain of other than nominal
   value offered as a result of the volunteer's or employee’s affiliation with the American Red Cross.

c. 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. Disclose or use any confidential American Red Cross information that is available solely as a
   result of the volunteer's or employee’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. 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.   Operate or act in any manner that is contrary to the best interests of the American Red Cross.

g. Operate or act in a manner that creates a conflict with the interests of the American Red Cross
   and any organization in which the individual has a personal, business, or financial interest. The
   individual shall disclose such conflict of interest to the American Red Cross chair of the
   appropriate governing board, the appropriate Chief Executive Officer, or the General Counsel, as
   applicable, upon becoming aware of it. Where required, the individual shall absent himself or
   herself during deliberations, and shall refrain from participating in any decisions or voting in
   connection with the matter.




                         http://www.snohomish county.redcross.org                               page 5 of 12
                                                                           Snohomish County Chapter
                                                                               2530 Lombard Avenue
                                                                                   Everett, WA 98201
                                                                                   Ph: (425) 252.4103
                                                                                  Fax: (425) 258-1599




                        American Red Cross Code of Conduct
                           Certification and Disclosure

I, _______________________________________, certify that I have read and understand the Code of
Conduct of the American Red Cross and agree to comply with it, as well as applicable laws that impact
the organization, at all times.

Disclosure of Actual or Potential Conflicts:

I affirm that, except as listed below, I have no personal, business, or financial interest with any
organization that conflicts, or appears to conflict, with the best interests of the American Red Cross:

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________


Future Actual or Potential Conflicts:

At any time during the term of my employment or volunteer status 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:

    a. Disclose promptly the actual or potential conflict to the chair of my unit, the executive of my unit,
       my department head, or the General Counsel, as applicable; and,

    b. Until Red Cross approves actions to mitigate or otherwise resolve the conflict, refrain from
       participating in any discussions, deliberations, decisions or voting related to the conflict of
       interest.




Printed Name



Signed Name



Date

                             http://www.snohomish county.redcross.org                               page 6 of 12
                                                                            Snohomish County Chapter
                                                                                2530 Lombard Avenue
                                                                                    Everett, WA 98201
                                                                                    Ph: (425) 252.4103
                                                                                   Fax: (425) 258-1599




                                                                                   Date:______________
                                     Volunteer Reference
The mission of the American Red Cross is “to provide relief to victims of disaster and to help people
prevent, prepare for and respond to emergencies”. This is primarily done through volunteers. You have
been asked to be a reference for someone who is interested in becoming a Red Cross Volunteer.

The purpose of this form is to best match the person below with the needs of our organization. All
responses are confidential and are only used to find the best volunteer position for this person. If you
have any questions or prefer to talk in person, please contact me directly at 425 –740-2327.

Please mail this form within 2 weeks to the Red Cross Volunteer Coordinator’s Office at the Red Cross
address in the letterhead. Thank you for your help!

Volunteer Coordinator

Name of Applicant _____________________________               Telephone Number (           )____________

How long have you known this person and in what capacity e.g. supervisor, co-worker, teacher etc...?
Please put answer here

Rate the applicant on the qualities below using the scale to the left, circle the number that best fits this
applicant:

           Outstanding           4           • Handles self well in crisis situations

           Very Good             3           • Works well with diverse clients

           Fair                  2           • Accepts responsibility and commitment

           Unacceptable          1           • Is dependable and reliable

                                             • Is tactful and courteous

Does this person need much supervision or direction: _________________________________________
What do you think would be the ideal volunteer position for this person?
_____________________________________________________________________________________
_____________________________________________________________________________________

Is there any other information that we would find useful regarding this applicant?
_____________________________________________________________________________________


                             http://www.snohomish county.redcross.org                             page 7 of 12
                                                                            Snohomish County Chapter
                                                                                2530 Lombard Avenue
                                                                                    Everett, WA 98201
                                                                                    Ph: (425) 252.4103
                                                                                   Fax: (425) 258-1599

Printed Name: ________________________________ Signature:_______________________________

Telephone: (       )______________________
                                                                                   Date:______________
                                     Volunteer Reference
The mission of the American Red Cross is “to provide relief to victims of disaster and to help people
prevent, prepare for and respond to emergencies”. This is primarily done through volunteers. You have
been asked to be a reference for someone who is interested in becoming a Red Cross Volunteer.

The purpose of this form is to best match the person below with the needs of our organization. All
responses are confidential and are only used to find the best volunteer position for this person. If you
have any questions or prefer to talk in person, please contact me directly at 425 –740-2327.

Please mail this form within 2 weeks to the Red Cross Volunteer Coordinator’s Office at the Red Cross
address in the letterhead. Thank you for your help!

Volunteer Coordinator

Name of Applicant _____________________________               Telephone Number (           )____________

How long have you known this person and in what capacity e.g. supervisor, co-worker, teacher etc...?
Please put answer here

Rate the applicant on the qualities below using the scale to the left, circle the number that best fits this
applicant:

           Outstanding           4           • Handles self well in crisis situations

           Very Good             3           • Works well with diverse clients

           Fair                  2           • Accepts responsibility and commitment

           Unacceptable          1           • Is dependable and reliable

                                             • Is tactful and courteous

Does this person need much supervision or direction: _________________________________________
What do you think would be the ideal volunteer position for this person?
_____________________________________________________________________________________
_____________________________________________________________________________________

Is there any other information that we would find useful regarding this applicant?
_____________________________________________________________________________________

                             http://www.snohomish county.redcross.org                             page 8 of 12
                                                                                  Snohomish County Chapter
                                                                                      2530 Lombard Avenue
                                                                                          Everett, WA 98201
                                                                                          Ph: (425) 252.4103
                                                                                         Fax: (425) 258-1599


Printed Name: ________________________________ Signature:_______________________________

Telephone: (            )______________________
                                          National Red Cross
     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:


                                http://www.snohomish county.redcross.org                                    page 9 of 12
                                                                                    Snohomish County Chapter
                                                                                        2530 Lombard Avenue
                                                                                            Everett, WA 98201
                                                                                            Ph: (425) 252.4103
                                                                                           Fax: (425) 258-1599

             (i)    in the course of Volunteer Service or using Red Cross time, equipment, information or materials, and
             (ii)   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.
Rev. 03/05




                                   http://www.snohomish county.redcross.org                                  page 10 of 12
                                                                                   Snohomish County Chapter
                                                                                       2530 Lombard Avenue
                                                                                           Everett, WA 98201
                                                                                           Ph: (425) 252.4103
                                                                                          Fax: (425) 258-1599


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 (i) in the course of Volunteer Service or using Red Cross time, equipment, information or materials,
        and (ii) 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                                                                    Date


                               http://www.snohomish county.redcross.org                                      page 11 of 12
                                      Snohomish County Chapter
                                          2530 Lombard Avenue
                                              Everett, WA 98201
                                              Ph: (425) 252.4103
                                             Fax: (425) 258-1599




http://www.snohomish county.redcross.org                page 12 of 12

				
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