Mattoon Haven Volunteer Application
Name *
First and last name
Your answer
Date Of Birth *
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Postal Address
Your answer
Phone number *
Your answer
Email *
Your answer
Employer
Your answer
Organization (Church, Club, ETC)
Your answer
In need of Fulfilling Community Service?
Preferred form of contact.
Volunteer Area of Interest?
What Days will you be available?
Emergency Contact
Your answer
Emergency Contact Number
Your answer
All applicants must answer the following question. Failure to answer honestly will disqualify the applicant as a volunteer at our organization.
Are you a registered sex offender
Signature
Your answer
Date
MM
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DD
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YYYY
Conflict of Interest for Board of Directors, Staff, and Volunteers
Any of the following will be viewed as a conflict of Interest and may not be undertaken without specific Board approval
• Transporting guest in your personal vehicle
• Lending or Borrowing money from guest
• Buying or selling any items to a guest
• Holding money or becoming rep payee for guest
• Having social contact outside the facilities or engaging in any relationship other than professional with a guest
• Paying a guest to perform work at the facility
• Giving gifts to a specific guest
• Asking a guest for a personal favors
• Providing favors to guest

A guest is any individual who is currently receiving services, or has received services in the last 12 months.
The Haven Confidentiality Policy
The Haven Confidentiality Policy is as follow:
All Board members, volunteers, interns, and employees must sign and strictly adhere to this confidentiality agreement. It states that the below mentioned individual will not tell anyone the name of clients of The Haven. I understand that maintaining confidentiality is an obligation which applies no only during the time of my association with the shelter, but also anytime thereafter.

This policy is effective as of December 31, 2003 and will remain in effect until The Haven is dissolved.
Print Name
Your answer
Date
MM
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DD
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YYYY
Phone Number
Your answer
E-Mail
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