Volunteer Cover Sheet - Microsoft



Volunteer Assignment

(To be completed by local staff to accompany Volunteer Packet)

Please Print

Volunteer Name: __________________________________ County: ____________________

Assigned Office: _________________________________ Unit Supervisor: _________________

Project Assignment: CWB___ Community Partners___ Paid___ (organization:_______________)

(Please check all that apply.)

Gen Ofc___ Intern___ Case Aide___ Transporting___ FPA___ Other X Rotary Group

Brief explanation of expected Volunteer Duties: _______________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

The Level Chart will assist in processing your applicant.

|Level of Volunteer |Definition |Application |Confidentiality Agreement |Central Registry/Criminal |TB Test Results |Compliance with Agency |

|Placement | |Required |Signed |Background Check Completed | |Driving Requirements |

|1 |No client contact (such |X |  |  | |  |

| |as a sock drive) | | | | | |

|2 |Inadvertent client |X |X |  | |  |

| |contact, no access to | | | | | |

| |confidential client | | | | | |

| |information (such as | | | | | |

| |stocking in DFPS office,| | | | | |

| |committee work) | | | | | |

|3 |Indirect client contact |X |X |X | |  |

| |or access to sensitive | | | | | |

| |case specific | | | | | |

| |information (such as | | | | | |

| |community boards, | | | | | |

| |inventory, deed | | | | | |

| |searches) | | | | | |

|4 |Direct client contact |X |X |X |X |  |

| |and/or access to | | | | | |

| |sensitive information | | | | | |

| |(such as case aide | | | | | |

| |duties, office | | | | | |

| |assistant, supervision | | | | | |

| |of visits, runaway | | | | | |

| |hotline) | | | | | |

|5 |Transports clients |X |X |X |X |x |

Return volunteer packet to your program contact: CPS – Donna Tabron – DFPS, P. O. Box 20097, Arlington, TX 76006-0697.

Please note that processing generally takes 1 week after the volunteer packet is received. Results will be sent to the above-named

supervisor or assigned contact (please list): _______________________________________.

Thank you for all you do to “protect those who are most vulnerable.”

Region 3 Volunteer Management & Community Engagement

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