Personal Information



e.g., She/Her/Hers, He/Him/His, They/Them/Theirs

Birthdate is required for WSP background check


Use 2-letter abbreviation








Emergency Contact

In the case of a medical emergency, I understand that Sound Generations will contact 911 and notify my emergency contact listed below.  


In the event of an emergency, the following person is authorized to act on my behalf:




Availability
Morning Afternoon
Service Availability




Service Availability




Driving Record






I authorize Sound Generations to submit a Driving Record Release of Interest form to the Washington State Department of Licensing.


Vehicle 1









Vehicle 2










Volunteer Acknowledgment of Sound Generations Policies

Visit our website; https://soundgenerations.org/get-involved/volunteer/ to review policies and then indicate your acceptance of these policies below

Anti-Harassment Policy

I hereby acknowledge that I have received a copy of Sound Generations’ written Anti-Harassment Policy.  I understand that Sound Generations affirms this policy and declares harassment and related retaliation unacceptable, and considers violations of this policy to be conduct subject to disciplinary review and action, up to and including volunteer termination, or expulsion from the center/program. 


Drug and Alcohol Policy

I hereby acknowledge that I have received a copy of Sound Generations’ written Drug and Alcohol Policy.  I understand that Sound Generations affirms this policy and declares intoxication and/or the abuse of substances to be unacceptable while volunteering, and considers violations of this policy to be conduct subject to disciplinary review and action, up to and including volunteer termination, or expulsion from the center/program.


Confidentiality Policy

I hereby acknowledge that I have received a copy of Sound Generations’ written Confidentiality Policy.  I understand that Sound Generations affirms this policy and declares the disclosure of client, volunteer, or staff information to unauthorized persons to be unacceptable, and considers violations of this policy to be conduct subject to disciplinary review and action, up to and including volunteer termination, expulsion from the center/program, or possible legal action.   I understand that the duty to maintain confidentiality survives the termination of my service with Sound Generations.


Conflict of Interest Policy

I hereby acknowledge that I have received a copy of Sound Generations’ written Conflict of Interest Policy.  I understand that Sound Generations affirms this policy and declares the exploitation of this position for personal gains or compensation to be unacceptable, and considers violations of this policy to be conduct subject to disciplinary review and action, up to and including volunteer termination, or expulsion from the center/program.  


Mandatory Reporting Policy

I hereby acknowledge that I have received a copy of Sound Generations’ written Mandatory Reporting Policy. I understand that as a Sound Generations volunteer I am considered a passive reporter.  This means that I will not face legal action for failing to report the witnessed or suspected abuse or exploitation of a vulnerable adult, but if I choose to I may contact DSHS and make an anonymous report.  If it is safe to do so, I will make a reasonable effort to communicate with a Sound Generations staff member if I witness or suspect the abuse or exploitation of a vulnerable adult.


Newsletter (Optional)

Sound Generations would like to send you updates about the work we do in our community to support people on their aging journey through community connections and accessible services. Please indicate if you would like to receive these updates.

Media Release (Optional)

I give full permission for Sound Generations to use volunteer- related images of me that appear in videos, printed materials, audio recordings, and/or quotes from my interviews/conversations with the Released Parties’ staff, donors, partners, and volunteers without compensation or further authorization.  This may include, but is not limited to, print broadcast, social media, electronic, or other media now or in the future.  I further agree that the images and/or voice recordings and/or printed communications shall ne the property of the Released Parties.  I give permission to the Released Parties to condense, reproduce and/or publish these materials, in whole or in part as it deems.



Volunteer Driver Statement of Understanding

I will use my own vehicle and may be reimbursed for expenses incurred, limited to mileage, parking, tolls and ferry fares. Only expenditures authorized by Sound Generations will be considered for reimbursement. Proper documentation must be submitted for any reimbursements.


I understand that my personal insurance is my primary liability protection while driving for the Volunteer Transportation Program and must be issued by a company authorized to do business in the State of Washington. I will immediately notify Volunteer Transportation Program staff if my personal insurance is revoked, cancelled or altered.


Sound Generations will provide general liability insurance for claims in excess of my policy at no cost to me during the course of assigned volunteer duties. This coverage includes Auto Liability insurance and umbrella liability insurance, and is excess over any other valid and collectable insurance that I have in force.


I understand that I am required to hold a valid Washington State Driver's License. I will notify Volunteer Transportation Program staff immediately if my driver's license is suspended, not current and/or valid or if the registration and license of the vehicle I use to transport riders are not current and/or valid. I will provide a copy of my current driver's license when the old one expires.


It is my responsibility to notify immediately and provide Volunteer Transportation Program staff with a copy of any reports issued by law enforcement agencies regarding: 

Any vehicle accidents in which I am involved. 

Any traffic citation that I may receive while this agreement is valid. 

This applies to all accidents in which I may be involved and/or any traffic citations I may receive while registered as a volunteer driver with Sound Generations, even if they occur outside the scope of my volunteer duties. I understand that failure to maintain a satisfactory driving record may result in my termination from the Volunteer Transportation Program.


I will not accept personal gratuities or tips from clients, but win encourage clients to make any donation directly to the Volunteer Transportation program in the envelopes provided. I will submit all client donations to Volunteer Transportation staff.


If a client's health should change such that they are no longer ambulatory, I will not physically assist the rider and will notify Volunteer Transportation staff.


I will notify Volunteer Transportation Program staff at the time I no longer wish to be involved in the program and return my assigned disabled parking placard, if applicable. Either Sound Generations or I may terminate this agreement at any time. I have read and understand the above statements.



Notification and Authorization to Release Criminal Information for Volunteer Purposes

Notification

The volunteer opportunity for which I am being considered requires me to consent to a criminal background check as a condition of employment.  This check includes the following:  criminal history reference searches for felony and misdemeanor criminal convictions for offenses against persons, civil adjudication of abuse or financial exploitation of a vulnerable adult and disciplinary board final decisions and subsequent criminal charges. If I am hired before that report is received, my employment (or volunteer opportunity) will be conditioned upon the receipt of a satisfactory report.

Authorization

I hereby authorize Sound Generations to conduct the criminal background check described above.  In connection with this, I also authorize the use of law enforcement agencies to assist Sound Generations in collecting this information.  Washington State Patrol has been secured as a third party vendor to assist Sound Generations in collecting and verifying information.

 

I also am aware that records of arrests on pending charges and/or convictions are not an absolute bar to employment.  Such information will be used to determine whether the results of the background check reasonably bear on my trustworthiness or my ability to perform the duties of my position in a manner which is safe for Sound Generations clients and employees.

In addition to the information entered on the first page of this application, we need the following:

If no Middle Name, check box below


Have you ever been convicted of a criminal offense or have any pending criminal charges against you? *This refers only to felonies and misdemeanors; you do not need to include non-criminal traffic violations or municipal ordinance violations.



UNDER PENALTY OF PERJURY, I certify that to the best of my knowledge, the information provided is true and complete. I understand that any falsification or omission of information may disqualify me for this position and/or may serve as grounds for the severance of my employment with Sound Generations.  By signing below I hereby provide my authorization to Sound Generations to conduct a criminal background check and I acknowledge that I have been informed that I may request a copy of the completed background check should I wish to receive one. 



OPTIONAL DEMOGRAPHIC INFORMATION

Sound Generations values diversity, and we want to make sure we are reaching people of all backgrounds, genders, and ages. This section is entirely optional. Responses will remain confidential and will be used only to improve our outreach efforts.