Volunteer Application Form

Thank you for completing our Volunteer Application.

  • References

  • Please list two professional references we may contact:
  • Background Information & Experience

  • Areas of Interest

    Please check all that apply.
  • Volunteer Requirements, Commitments, and Acknowledgement

  • At Full Circle Grief Center, we will frequently be observers and recipients of confidential information concerning participants and their families. Facts or situations in the participant’s life will be communicated, with the implicit understanding that this information will not be shared with others.

    Confidentiality is the preservation of information concerning participants in our programs. It is based upon the basic right of privacy and is an ethical obligation of the clinician. Confidentiality is essential to building the trust of the members and creating a safe environment for feelings to be shared.

    As clinicians and volunteers, we will share information about group participants during the group debriefing periods. As staff members, we will share information during internal consultations and clinical meetings. When participants come to Full Circle, they review the “Exceptions to Privacy”, which outline times like this when their information is shared with others within the organization. This sharing between the staff, clinicians, and volunteers is essential to making sure we are meeting the needs of the families in the best way possible.

    All staff members, clinicians, and volunteers are bound by confidentiality to not discuss information about any family with anyone except staff members or contract clinicians and volunteers participating in your current group/program. If you are a student and are utilizing your volunteer experience for school credit, please do not discuss the name of the family or any details about the death with your professor or classmates. Doing so would be a violation of confidentiality.

    Confidentiality will always be preserved, with the exceptions noted below.
  • Please initial to acknowledge.
  • Please initial to acknowledge.
  • Please initial to acknowledge.
  • Please initial to acknowledge.
  • Before you take any action to break confidentiality, please contact Allyson Drake, Full Circle’s Executive Director or your Program Director.
  • AUTHORIZATION/CONSENT
    FOR BACKGROUND VERIFICATION DISCLOSURE

  • During the application process and at any time during the tenure of my employment/service with Full Circle Grief Center, I hereby authorize ChoicePoint Services Inc., on behalf of Full Circle Grief Center to procure a consumer report which I understand may include information regarding my character, general reputation, or personal characteristics.
  • This is used to inform you that a consumer report is being obtained from a consumer reporting agency for the purpose of evaluating you for employment, volunteer service or a contracted position, including retention as an employee, volunteer or independent contractor.

    I understand that I may request a complete and accurate disclosure of the nature and scope of the background verification, to the extent such investigation includes information bearing on my character, general reputation, or personal characteristics.