Volunteer Application | Hiawatha Homes, Inc. & Hiawatha Homes Foundation

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Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Have you ever applied to and/or worked for Hiawatha Homes in the past?*

Yes
No

Have you ever volunteered at Hiawatha Homes in the past?*

Yes
No

What program did you work/volunteer in?

What dates were you employed/a volunteer at Hiawatha Homes?

Can you provide verification that you are at least 18 years of age or older (volunteers younger than age 18 must have consent of a parent or guardian)?*

Yes
No

Because Hiawatha Homes is licensed by the Department of Human Services, which requires background studies to be conducted for people providing direct contact services, do you understand that all volunteers must be able to successfully pass a background study to be considered for service?*

Yes
No

Do you have a current and valid driver's license?*

Yes
No

Hiawatha Homes has a strict tobacco use policy, prohibiting the use of tobacco during shifts or on Hiawatha Homes properties. Are you willing to abide by these restrictions?*

Yes
No

Are you willing and able to volunteer in a home with pets, such as cats, dogs or fish?*

Yes
No

Please describe any previous experience you have working with individuals with disabilities.*

Please describe any other volunteer experience you have.*

Please share some of your interests/hobbies/skills.*

Please indicate which of the following activities you would be willing assist with::*

Select All
Cleaning/Disinfecting
Grocery Shopping/Delivery
Meal Prep/Delivery
Laundry (off-site)
Staff Transportation (using a HH vehicle)
Creating video greetings
Other

Please explain your other volunteer activity ideas:

We would be honored to have you continue to volunteer following the COVID-19 pandemic. If you're interested, please indicate which of the following activities you would be willing to do with individuals supported:

Please explain your other volunteer activity ideas:

Days I am available to volunteer:

Select All
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Monday availability:

Tuesday availability:

Wednesday availability:

Thursday availability:

Friday availability:

Saturday availability:

Sunday availability:

Desired number of volunteer hours:*

Date available to start:*

Volunteer Applicant Consent Statement

I promise that the information provided in this volunteer application is true and complete, and I understand that any false or misleading information or significant omissions may disqualify me from further consideration, and may lead to my dismissal. I understand that all volunteer positions are based on an at-will status. As an at-will volunteer, I understand that I may terminate my volunteering at any time, for any reason, with or without cause, notice or prior warning. Hiawatha Homes is an equal opportunity employer and will not discriminate against an applicant, volunteer or employee on any grounds protected under federal, state, or local law. None of the questions in this application are intended to elicit information regarding any protected characteristic(s), nor employ any limitation, illegal preference or discrimination based upon non-job-related information or protected characteristic(s). Hiawatha Homes complies with all applicable legal requirements in its hiring and volunteer placement processes and related tests and background checks. I understand that this volunteer application does not create a contract of employment. I agree to treat everyone, including staff, supported individuals, and other persons with dignity and respect. I understand that, as a volunteer for this agency, I am representing Hiawatha Homes and the individuals who live here and agree to conduct myself in a professional and polite manner at all times. I understand and agree to respect all agency policies, especially those regarding confidentiality and data privacy.

Acceptance of Consent Statement*

I have read, understand and agree to the Volunteer Applicant Consent Statement.

Applicant Signature*

Please type your name below. This will serve as your formal application signature.

Application Date*

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