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Volunteer Application

  Please complete the following application if you would like to be an ACTS volunteer. You may submit the application via email with this form or fill out the print version and mail to :
   
  ACTS Volunteer Coordinator
P.O. Box 74
Dumfries VA 22026
 
 
*Required Fields
* First Name * Last Name
* Address * City
* State * Zip
* Date of Birth * Email Address
Home Phone
(012-345-6789)
* Work/Cell Phone

(012-345-6789)
 
How did you hear about the ACTS Volunteer Program?
 
 
* If you are Volunteering to fulfill a Community Service Requirement, please provide the following information:
 
Yes No
 
Reason for Community Service?  

Number of Hours Required

  
Required Completion Date   (mm/dd/yy)
 
* Emergency Contact Information:
 
Name Relation
Phone #1 Phone #2
 
Educational Background:
 
Highest Level Attained
Field of Study
Current Occupation or
Volunteer Position
 
For which ACTS Program would you like to Volunteer?
 
Turning Points Help Line Food Pantry    
Emergency Assistance Maintenance Thrift Store    
Transitional Living Shelter        
 
Which Volunteer opportunities interest you?
   
 
  General Office duties (typing, telephone, etc.)
  Fundraising Committee
  Enroll in training to directly assistance to clients:
  "Adopt" a room in one of the shelters
  Help organize food drives
  Emergency Assistance Caseworker (Requires a 6 month commitment )
  Translate for a non-English speaking clients
  Assist with Grant writing & research
  Help with bulk mailings and newsletters
  Turning Points Advocate/Group Leader
  Helpline Phone Listener
  Teach a life skills class
  Babysit for a client attending life skills classes
  Receive & Stock donations at the ACTS Thrift Store
  Work in the Emergency Food Pantry
  Pick up donated food and other items from local businesses (Requires a car)
  Assist with Thrift Store pick-ups
  Maintain play areas and shelter grounds
  Plant flowers and shrubs in shelter yards
  Assist with special events and fundraiser's
 
* Availability (please list the days and hours you would like to work)
 
  Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Morning
Afternoon
Evening
 
 
I would Prefer Regular Schedule
  Flexible Schedule
  On Call as Needed
 
Is there anything else that you would like us to know about you?
 
 
PLEASE READ AND SIGN BELOW (Items marked with an asterisk are required)
ACTS Photography and Publishing Release Form (Optional)
I agree to allow photographs and video of me taken by Action in Community Through Service of Prince William, Inc. (ACTS) or its designee to be published for any purpose and in any format. This release covers photographs and videos taken by ACTS.
ACTS Code of Ethics (required)

All Volunteers of ACTS will agree to abide by the following code of ethics:
As an ACTS Volunteer, I agree to:

  1. Respect and protect clients' rights to privacy by treating as confidential all information revealed by a client.
  2. Adhere to ACTS' administrative policies and supervision
  3. Accept the right of the client to maintain his own value system and lifestyle
  4. Be dependable in honoring all commitments to clients.
  5. Act with integrity and forthrightness in association with clients, fellow volunteers and ACTS staff members.
Confidentiality Statement (required)
I agree to treat all information revealed to me as confidential. I will do my best to live up to my volunteer commitment and I will notify my supervisor in advance if I must miss my assignment for any reason. All volunteers of ACTS treat all clients with respect for basic human dignity and follow sound principles of human growth and development. ACTS encourages self determination and empowerment.
Statement of Verification (required)
The above statements are true and all information and reference given on this application may be investigated without liability of Action in Community Through Service (ACTS). If accepted to participate in the ACTS Volunteer Program, I agree to abide by the policies of the ACTS Program. I understand that if any of the statements in this application are found to be untrue, or I fail to comply with all stated requirements, I may be subject to immediate dismissal from the ACTS Volunteer Program.
 
 
* Full Name:
Applicants desiring to work with children will be required to submit a background check and sign an agreement of confidentiality.
Thank you for your time. Once you have filled out the application please call 703-441-8606, ex. 213
M-F 8:30 - 4:30
 
 
 
 
 
 

 
 

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