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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