Volunteer Application

For Individual Volunteers

Fill out the form below to apply to become a volunteer. Looking to bring a group to volunteer? Fill out our group application.

"*" indicates required fields

1Contact Information

2Circles USA

3Background Screening

4Confidentiality Agreement

5Handbook and Waiver

6Handbook and Waiver (Under 18)

Contact Information

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Birthdate

Month

Day

Year

Gender

Male

Female

Volunteer Information

How did you hear about us?

Why do you want to volunteer?

Place of Worship

Do you have any physical needs that require special arrangements?

Yes

If yes, please explain

Days and time available

How often do you want to volunteer?

Once a week

Once a month

One time

Every now and then

Skills and Experience

Education

GED or High School Diploma

Associate's Degree

Bachelor's Degree

Master's Degree

Ph.D.

Volunteer Skills & Additional Information

Volunteer Interests

Serve a Meal

Clean and Organize

Pick Up Food

Help Job-Seekers

Drive Residents

Coffee Service

Deliver Furniture

Re-Entry Program Volunteer

Go Inside the Jails

Office Work

Garden

Laundry Ministry

Become a Circles Volunteer

Building Maintenance Help

Emergency Contact & Relationship to You

Emergency Contact's Phone Number

Is there any other background information you would like to disclose?

I approve of Lexington Rescue Mission taking photographs of me and sharing them on social media and in print publications.

Yes

Circles USA

Additional Phone

Preferred method of contact

Call My Phone

Text Me

Call My Additional Number

When are you available?

Monday Morning

Monday Afternoon

Monday Evening

Tuesday Morning

Tuesday Afternoon

Tuesday Evening

Wednesday Morning

Wednesday Afternoon

Wednesday Evening

Thursday Morning

Thursday Afternoon

Thursday Evening

Friday Morning

Friday Afternoon

Friday Evening

Saturday Morning

Saturday Afternoon

Saturday Evening

Sunday Morning

Sunday Afternoon

Sunday Evening

Place of Employment

Please list your children (age 18 and under) with name, age, and if they would attend children's program:

Please list anyone else living in your home and their relation to you:

Speak and read English

Yes

Motivated to learn and apply new ideas

Yes

Are you willing to build relationships across class and cultural lines?

Yes

Able to attend weekly classes or meetings

Yes

Supported and encouraged by family to participate in Circles

Yes

Relatively stable (not currently homeless, dealing with domestic or drug abuse)

Yes

What languages do you speak fluently?

How did you hear about Circles?

Is there a specific volunteer role or task at Circles that interests you?

Weekly Meeting Meal

Weekly Meeting Hospitality

Children’s Program

Services Team

Jobs and Education Team

Recruitment Team

Big View Team

Data collection and entry

Fundraising

Other

What behaviors do you find most frustrating in people?

What would you like us to know about you before we work together?

What are you good at? What are you not so good at?

Background Check

Background checks are required for participation in any activities where children may be present.

Have you ever been convicted of a felony?

Yes

If yes, explain:

Do you currently have a court case pending?

Yes

If yes, explain:

Do you have any active warrants?

Yes

If yes, explain:

Emergency Contact

First Last

Emergency Contact Phone

Emergency Contact Address

Street Address Address Line 2 City State ZIP Code

Agreements

Your Circles chapter, legally named Circles Lexington, together with Circles USA, (jointly referred to as “Circles”) request that you agree to the following Code of Conduct and Statement of Confidentiality. Please read them and sign below to indicate your agreement with these statements.

Code of Conduct for All Circles Meetings, Activities, and Events

I will dedicate myself to supporting all participants and volunteers. I will respect the inherent dignity of every person without regard to their race, ethnicity, creed, age, religion, disability, sexuality, or nationality. I will be honest and strive to be a person of integrity. I will follow Circles’ rules and policies for volunteers. I will not engage in activities which may be seen as a conflict of interest between Circles and myself. I will contribute to a safe environment by not harming others in any way, whether through discrimination, harassment, exploitation, abuse, or neglect. During meetings, I will not be under the influence of illegal drugs or alcohol. If I need to end my commitment to Circles, I will step down considerately and in a way that minimizes disruption to the community.

Statement of Confidentiality

I agree to ensure the confidentiality and privacy of all who participate including Circle Leaders, Allies, volunteers, and staff. I understand that the fact that an individual is served by Circles must be kept confidential, and at no time will I disclose personal information that is shared at Circles meetings. I understand that Circles maintains a strict policy on the confidentiality of my records. All information I share, or which Circles becomes aware of through my involvement will remain confidential and will not be shared with anyone outside of Circles unless I have given my written permission. I understand that there are some situations where this confidentiality policy becomes void, and staff are required by law to release information. These circumstances include: (1) If Circles becomes aware that I may be a danger to myself or others; (2) If Circles become aware of an adult, elder, or child abuse situation taking place; (3) If Circles is under court order to share information.

Signature

Date

MM slash DD slash YYYY

MEDIA RELEASE - ADULT

Your Circles chapter, legally named Circles Lexington, together with Circles USA, (jointly referred to as “Circles”) sometimes use photos and videos of participants and volunteers in social media and promotional materials. Please read the below media release and sign if you agree to these terms. I grant permission to Circles to use my image (whether photograph or video) in its media publications including emails, brochures, publications, presentations, videos, social media, and websites. I waive any and all rights to inspect or approve of the photographs or media prior to their use. I waive any rights to royalties or compensation arising from use of these images.

Media Release Agreement - Self

Yes

Media Release Agreement - My children until they are 18 years old

Yes

Signature

Date

MM slash DD slash YYYY

Lexington Rescue Mission, Inc. Background Screening Consent

Consent

I hereby authorize Lexington Rescue Mission and/or its agents to make an independent investigation of my background which may include: references, character, past employment, education, credit history, adult criminal or police records and motor vehicle records including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my Application and/or obtaining other information which may be material to my qualifications for service now and, if applicable, during the tenure of my employment or service with Lexington Rescue Mission. I release Lexington Rescue Mission and its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above referenced sources used. The following is my true and complete legal name and all information is true and correct to the best of my knowledge:

Agreement

Lexington Rescue Mission may contact me for further personal information required for a background check

Signature of Applicant

*NOTE: The above information is required for identification purposes only, and is in no manner used as qualifications for employment, or service as a volunteer. Lexington Rescue Mission abides by all applicable state and federal employment laws.

Date

MM slash DD slash YYYY

Volunteer Confidentiality Agreement

Consent

I agree to the I agree to maintain confidentiality as a condition of my volunteer position due to potential access to information that is confidential and/or intended for organizational use only. I recognize that unauthorized release of confidential information may make me subject to a criminal action. I understand that the below are listed examples of, but is not an all-inclusive list, of such confidential information: ▪ Donor lists and information ▪ Outreach Center client information ▪ Potter’s House and Broadway House resident information ▪ Re-entry Program participant information ▪ Jobs for Life participant information Volunteer Responsibility All employees and volunteers are required to protect each client’s right to privacy. This applies to records kept for the purpose of identifying clients as well as materials presented solely for reference purpose. Volunteers serving at any Lexington Rescue Mission location must sign and adhere to this policy of confidentiality. Volunteers who are granted access to Lexington Rescue Mission’s online computer system in the course of their service are asked to strictly maintain the privacy of all clients by not divulging any personal information to anyone other than Lexington Rescue Mission personnel. As a Lexington Rescue Mission volunteer, I understand and agree to the ‘Confidentiality Policy’ as described above. I also understand that violating this policy may result in possible dismissal from my volunteer position with the Lexington Rescue Mission.privacy policy.

Volunteer Signature

Date

MM slash DD slash YYYY

Lexington Rescue Mission Volunteer Handbook and Waiver:

Review the Lexington Rescue Mission Volunteer Handbook

Consent*

I understand I am volunteering to perform work duties for Lexington Rescue Mission without expectation of wages or other compensation for my work. I am serving as a volunteer and not as an employee, and as such, I realize I have no legal claim for minimum wages, overtime, premiums, unemployment compensation or other provision of law for employees. Rather, it is my desire to help the mission accomplish its God-given purpose. I hereby waive and release all claims I may have as a result of volunteering against Lexington Rescue Mission and their officers, agents, servants, and employees. Additionally, I have reviewed the Volunteer Handbook and adhere to all policies included.

Volunteer Name*

First Last

Volunteer Signature*

Date*

MM slash DD slash YYYY

Lexington Rescue Mission Volunteer Handbook and Waiver (Under 18):

Review the Lexington Rescue Mission Volunteer Handbook

Are you the parent/guardian of a volunteer under the age of 18?*

Consent*

Volunteer Name*

First Last

Parent/Guardian Name*

First Last

Parent/Guardian Signature*

Date*

MM slash DD slash YYYY

Volunteer Application

For Individual Volunteers

Contact Information

Volunteer Information

Skills and Experience

Volunteer Skills & Additional Information

Circles USA

Background Check

Agreements

MEDIA RELEASE - ADULT

Lexington Rescue Mission, Inc. Background Screening Consent

Volunteer Confidentiality Agreement

Lexington Rescue Mission Volunteer Handbook and Waiver:

Lexington Rescue Mission Volunteer Handbook and Waiver (Under 18):

Contact Us

Impact in Your Inbox