19/10/2017
IVERIA EAST AFRICA INTERNSHIP AND VOLUNTEERING PROGRAM
APPLICATION FORM
Personal Information
First Name………………………………………………………………Last Name………………….,……………………….…………………………
Date of Birth……………………………………………………………Nationality…………………………………………………………………….
Gender …………………………………………………………………….Marital Status…………….………………………………………………..
ID Number/Passport Number…………………………………………………………………………………………….…………………………
Email Address…………………………………………………………………………………………………………………………………………………..
Emergency Contact
Name ………………………………………………………………………………………………………..……Relationship……………………………………………………………………………….
Telephone …………………………………………………………………………………..………………..
EDUCATION BACKGROUND
School Name of the school or course of study Year Completed Currently Attending
High School
College
Other
Special Training or Skills
Received
EMPLOYMENT HISTORY
Employer Job Title Period (from – to ) Reason for Leaving
VOLUNTEER EXPERIENCE
Organization Volunteer work done Period (from – to ) Reason for Leaving
How long are you applying for volunteer?
How often would you like to volunteer?
Please indicate the skills and experience you would like to bring to your volunteer ship.
What are your reasons for volunteering?
Please list two references, past and present employer, teachers or volunteer superior (we cannot accept family members or personal friend as references)
Name ……………………………………………………………………………Relationship ……………………………………………………
Phone Number/Email ………………………………………………………………………….
It is the policy of the CCI to screen all prospective volunteers. Therefore, I hereby authorize CCI to check my references, and I understand that a criminal background check is required. While we try to place every applicant we reserve the right to select applicants according to our needs and criteria.
I understand and respect the confidential nature for the information I might have access to in performing my volunteer duties for the organization.
As a volunteer for CCI I agree to abide by all applicable rules and regulations of the home. I understand that I will receive no monetary benefits in turn for my volunteer service and that CCI may terminate this agreement at any time without prior notice for any reason. I understand that after I submit my application it will be received and my eligibility for volunteer work will be determined. I agree to an interview with the in charge and on-site orientation to perform my volunteer role.
Volunteer Signature ……………………………........... Date…………………………………………….
For Office Use Only
Date received …………………………………………………………….Date interviewed…………………………………………………
Name and Signature of the Supervisor………………………………………………………………………………………………………
Additional comments ………………………………………………………………………………………………………………………….......
………………………………………………………………………………………………………………………………………………………………….
Volunteer Agreement
This agreement of volunteer ship is made the ………………………………….day of…………………….20………............
Between (volunteer)………………………………………………………………………..of (Address)…………………………………..
And (organization)……………………………………………….of P.O Box……………………………………………………………………
Hereafter known as (Org)………………………………………………………………………………………………………………………….
Regulations and conditions of volunteering as set herein will be deemed to constitute an agreement of volunteering in fulfillment for current volunteer ship agreement.
i. Date of Commencement……………………………………….day of…………………………20…………….
ii. Place of Work: you shall be based for the time being at……………………………………………………………..
iii. Job Functions: you shall be answerable to …………………………………who will assign you daily/weekly duties, and you shall also be required to carry out associated functions as he CCI may require from time to time (see attached job description)
iv. The Length of Service: You shall be on volunteer service for the period of …………………months after which the organization will terminate your volunteer ship.
v. Hour of work: the hours of work shall be from……………..am to……………….pm
vi. Monetary Considerations: You will carry out duties on voluntary basis hence no claim for salary, honorarium or any other form of benefits as a result of carrying out assigned tasks. However, the organization may cater for the following job related expenses……………………………………………….....................................................................................................................................................................................................................................................................................................................
vii. Absence through Illness: The supervisor must be notified as early as possible before 9. 00am if you are unable to attend duty, and medical certificate must be presented back to the work station.
viii. Grievance Procedure: Grievance raised by a expeditiously and fairly resolved
ix. Dismissal: the organization hopes that it will not become necessary to dismiss a volunteer, but if it becomes necessary after the ascertainment of evidence, the following procedures shall be followed:
The volunteer shall receive a first verbal warning.
The volunteer shall receive first written warning
The volunteer shall receive final written warning, and if no change appears,
The volunteer shall be dismissed in the event of it becoming absolutely clear that no improvement is forthcoming.
x. Dressing: All volunteers are expected to conform to acceptable standards of dressing to ensure that the image portrays professionalism approach of the organization.
xi. Confidentiality: You shall not be allowed to disclose to any person, or to use for your own benefit any confidential information e.g. photos, videos e.tc. , that you may receive or obtain in relation to the affairs of the organization or its clients.
xii. Code of conduct:
Demonstrate integrity, respect and professionalism to all.
If participating in direct fundraising activity, I understand that it is an offence not to return to CCI any monies collected on behalf of CCI.
To show loyalty and belief in work of the organization.
To abide by the policies of the CCI that protects the organization, staff and children and more so uphold the expected behavior protocol outlined in child protection policy and if I do not understand any of these policies, I should seek clarification from the supervisor or in charge of the home.
I agree to be bound by the regulations and conditions of the volunteer ship agreement
Signature of Volunteer………………………………………………..Date………………………………………..
Signature of in charge of the CCI………………………………….Date…………………………………………
