2015 Volunteer Application- The Historic Ephrata Cloister

2015 Volunteer Application- The Historic Ephrata Cloister
General Availability
Please list range of hours; AM or PM
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
The Ephrata Cloister has a wide variety of volunteer opportunities. Please check off your areas of interest.
Tour Guide: provides 45 minute tours of the site
Special Events Assistant:
set up and clean up of events, parking assistance, directional assistance, bake sale assistance
Education Programs: school tours, site wide family days
Gift Shop Assistance:
packing, unpacking, cleaning shelves,
Front Desk Associate: processing admissions
Maintenance/Gardens: weeding and maintaining gardens; lawn maintenance
Contact Information & Experience
Name
Street
Address
City, State,
Zipcode
Phone
Cell phone:
Email
Address
Best method
of contacting
you:
Preferred to be called:
Do you have any family members or
friends who volunteer for the Historic
Ephrata Cloister?
The Historic Ephrata Cloister 632 West Main Street Ephrata PA 17522 717-733-6600 [email protected] www.ephratacloister.com
If yes, please list their names:
Personal Reference Name:
(other than a relative)
Daytime phone:
Relationship:
Briefly describe previous volunteer
experience:
Briefly describe your work
experiences, skills, and interests that
would transfer into your volunteer
services at the Historic Ephrata Cloister:
How did you hear about our
volunteer opportunities?
Medical Information: *release is optional but will be kept confidential
Date of Birth
(MM/DD/YY)
*Allergies:
*Physician:
*Hospital Preference:
*Please list any medical conditions that
might affect your ability to perform your
duties or that your supervisor should be
aware of:
Emergency Contact Information
Name
Relationship
Phone
Cell phone:
The Historic Ephrata Cloister 632 West Main Street Ephrata PA 17522 717-733-6600 [email protected] www.ephratacloister.com
Background Checks
An applicant for a volunteer position who is 14 years and older, who has direct contact with a child, particularly
school and education program volunteers, special events assistants, and tour guide volunteers, is required to
obtain the following upon commencement of service:
1. A Pennsylvania State Police Criminal Background Check completed by the Pennsylvania State
Police (PSP); located here: https://epatch.state.pa.us/Home.jsp
2. A child abuse history check conducted by the Pennsylvania Department of Public Welfare located
here: https://www.compass.state.pa.us/CWIS or (1-877-371-5422) For questions regarding your Pennsylvania Child
Abuse History Clearance Application, contact ChildLine at 1-877-371-5422.
These two background checks must be renewed every 36 months.
Additionally, a fingerprint based federal criminal history (FBI) Clearance is required if the volunteer is
applying for a paid position and/or the volunteer has lived outside the Commonwealth of Pennsylvania in the
last 10 years.
Volunteers who are not required to obtain the FBI clearance because they are applying for an unpaid
position and have been a continuous resident of Pennsylvania for the past 10 years must sign the Disclosure
Statement Application for Volunteers contained in the Volunteer Handbook appendix confirming that they
cannot be disqualified from service based upon a past conviction of an offense in other states that would
prohibit their selection as a volunteer.
Volunteers are required to obtain updated clearances as follows:
Within 36 months of the date of the most recent clearance;
By July 1, 2016 if the clearance is older than 36 months or
By July 1, 2016 if they were approved as a volunteer before July 1, 2015 and had not received a clearance
because they previously were not required to obtain clearances.
Volunteers are responsible for taking the personal initiative to obtain background checks and provide
copies of background checks to the Ephrata Cloister Associates.
Renewal Requirement:
Clearances less than three months old will be considered acceptable and compliant. If the
Ephrata Cloister Associates chose to renew all clearances at the same time, the date of the oldest clearance
rather than the most recent would be used.
Cost:
Background checks are provided at no cost to the volunteer if the volunteer purchases and provides
documentation of an ongoing annual membership to the Ephrata Cloister Associates.
If the volunteer obtains the background checks, pays for their renewal after 3 years, and provides over
25 hours of annual service, a one-year membership to the Ephrata Cloister Associates will be provided.
The Historic Ephrata Cloister 632 West Main Street Ephrata PA 17522 717-733-6600 [email protected] www.ephratacloister.com
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete.
I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations
made by me on this application may result in dismissal.
I understand that as a volunteer, I will not be paid for my services.
I understand that I will follow the health and safety standards established for the Historic Ephrata Cloister and I
agree to abide by the same policies.
It is the policy of this organization to provide equal opportunities without regard to race, religion, national
origin, gender, sexual preference, age, or disability.
Name (printed)
Signature
Date
Thank you for completing
this application form.
If we have not already
scheduled a screening, we will
contact you to schedule an
informal interview.
Additional forms, policies
and other documents will be
provided to you upon receipt
of the application in the form
of the Volunteer Handbook.
Please return completed form to:
Rebecca Lawrence
Museum Program & Volunteer Facilitator
The Historic Ephrata Cloister
632 West Main Street
Ephrata PA 17522
[email protected]
Volunteers are encouraged to become members of the Ephrata Cloister Associates. For more information please visit:
http://www.ephratacloister.org/members.htm or call Maria Asin 717-733-6600.
The Historic Ephrata Cloister 632 West Main Street Ephrata PA 17522 717-733-6600 [email protected] www.ephratacloister.com