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References: Please provide one professional and one personal reference, other than family members. References will be contacted by H-NCSSS staff.
Applicant Consent: I certify that the information in this application is accurate. I am willing to undergo a background check, which involves obtaining a police check. I understand that my application and all information contained herein will be held in strict confidence by Haldimand-Norfolk Community Senior Support Services Inc., and will not be released to any outside party
Consent to photographs / video taping / sound recordings: I hereby authorize Haldimand-Norfolk Community Senior Support Services Inc. and any person authorized by it, to take and produce photographs, video tapes, sound recordings and any other audio, media coverage and/or visual reproduction for H-NCSSS.
Confidentiality Agreement: As a volunteer of Haldimand-Norfolk Community Senior Support Services Inc., I will respect and maintain the confidentiality of information gained as a volunteer.
I also pledge to respect and maintain the confidentiality of individual personal information about persons who are clients, employees, or volunteers of H-NCSSS. At all times I will respect the privacy of clients and volunteers, their families, and other employees and volunteers.
I will ensure that private and confidential information is not inappropriately accessed, used or disclosed. I understand and agree to abide by the conditions outlined in this agreement which will remain in effect even if I cease to have an association with H-NCSSS.
I understand that such adherence is a condition of my volunteer work. I understand that a violation of this agreement may be grounds for termination as a volunteer.
