Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Language(s) Spoken *

English

Spanish

Other

Preferred Volunteer Region *

Seneca, SC

Easley, SC

Volunteer Roles *

Please select area(s) of interest.

Mentor

Youth Mentor

Children's Program

Fundraising

Outreach

Career Development

General Office / Admin Assistance

General IT / Tech Support

Ripple Resale

Health Coach

Car Care

Other

I affirm, agree, and understand that all statements on this application are true and accurate. I consent and grant permission to Ripple of One to check with appropriate authorities upon matters of record regarding my background or history. I release all corporations, employers, education institutions, law enforcement agencies, city, state, county, and federal courts, military service, and persons to release information they may have about me to Ripple of One. This releases Ripple of One from any liability and responsibility for collecting any information. *

Digital signature

First Name

Last Name

Respecting the privacy of our clients, donors, members, staff, volunteers and of Ripple of One itself is a basic value of Ripple of One. Personal and financial information and records are confidential and should not be disclosed or discussed with anyone without permission or authorization from Stephanie Enders or Dreama Clay.

Care shall also be taken to ensure that unauthorized individuals do not overhear any discussion of confidential information and that documents containing confidential information are not left in the open or inadvertently shared. Employees, volunteers, and board members of Ripple of One may be exposed to information which is confidential and/or privileged and proprietary in nature. It is the policy of Ripple of One that such information must be kept confidential both during and after employment or volunteer service. Ripple of One relies on staff and volunteers conforming to this rule of confidentiality. Staff and volunteers, including board members, are expected to return materials containing privileged or confidential information at the time of separation from employment or expiration of service.

Unauthorized disclosure of confidential or privileged information is a serious violation of this policy and will subject the person(s) who made the unauthorized disclosure to appropriate discipline, including removal/dismissal. General information, policy statements or statistical material that is not identified with any individual or family is not classified as confidential. This policy is intended to protect you, our clients, and Ripple of One.

Rationale: Confidentiality is the preservation of privileged information. By necessity personal and private information is disclosed in a professional working relationship. Part of what you learn is necessary to provide services to the applicant or client; other information is shared within the development of a helping, trusting relationship. Therefore, most information gained about individual clients through an assignment is confidential in terms of the law, and disclosure could make you legally liable. Disclosure could also damage your relationship with the client and make it difficult to help the person. Before you begin your assignment as a staff member/volunteer, you should be aware of the laws and penalties for breaching confidentiality. Although the agency is liable for your acts within the scope of your duty, giving information to an unauthorized person could result in the agency's refusal to support you in the event of legal action. Violation of the state statutes regarding confidentiality of records is punishable upon conviction by fines or by imprisonment or by both.

Certification: I have read Ripple of One’s policy on confidentiality and the Statement of Confidentiality presented above. I agree to abide by the requirements of the policy and inform my supervisor, the Program Director, or Client Care Manager immediately if I believe any violation (unintentional or otherwise) of the policy has occurred. I understand that violation of this policy will lead to disciplinary action, up to and including termination of my service with Ripple of One. *

Digital signature

First Name

Last Name