PPSC Volunteer Application 2019
Contact Information
First Name *
Your answer
Last Name *
Your answer
Home Phone *
Your answer
Work Phone
Your answer
Email *
Your answer
Street Address *
Your answer
City, State, ZIP Code *
Your answer
Availability
During which hours are you available for volunteer assignments?
Interests
Tell us in which areas you are interested in volunteering
Special Skills or Qualifications
Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports.
Your answer
Previous Volunteer Experience
Your answer
Person to Notify in Case of Emergency
Name
Your answer
Home Phone
Your answer
Work Phone
Your answer
Email
Your answer
Street Address
Your answer
City, State, ZIP Code
Your answer
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am
accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this
application may result in my immediate dismissal.

In California, failure to maintain client information as confidential is considered a violation of privacy. Volunteers
are acting on behalf of PPSC and are therefore subject to the same requirements and laws regarding
confidentiality as employed staff.

Confidential information includes:
- The fact that a person is or has been a client of PPSC
- Any information given to the volunteer in confidence by the client
- Any information about the client, his/her problems and treatment or contact with the agency

Confidentiality does not include:
- Suspected child abuse, elder abuse or intent to physically harm one’s self or another person. (The
volunteer coordinator should be called immediately if these issues arise).

Basic principles of confidentiality:
- All information divulged by the client to an agency representative is held in the strictest of confidence;
clients of PPSC are guaranteed this protection by California law.
- The volunteer should not communicate confidential information to anyone outside PPSC.
- Breach of confidentiality is sufficient grounds for termination of volunteer staff.

I have read and understand the above conditions. I shall make my best effort to fulfill my commitment to the
PPSC by completing all assignments that I accept. I shall at all times uphold the mission of the agency. All
information is to be held in the strictest of confidence.
Name (by typing your name you are agreeing to the above terms)
Your answer
Date
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Our Policy
It is the policy of this organization to provide equal opportunities without regard to race, color, religion,
national origin, gender, sexual preference, age, or disability.

Thank you for completing this application form and for your interest in volunteering with us.

Petaluma People Services Center is dedicated to improving the social and economic health of our community by providing programs that strengthen the dignity and self-sufficiency of the individual.
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