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Dress for Success

VOLUNTEER QUESTIONNAIRE 

APPLICATION

Dress for Success

DFS Volunteer Form

Welcome to Dress for Success Dutchess County!  We are a volunteer-driven program of Dutchess County Community Action Agency that provides interview-appropriate clothing and employment retention support to disadvantaged women transitioning into the work force.  We are excited to learn more about you and your interest in becoming part of the Dress for Success Dutchess County volunteer team! 
In an effort to best match your interests with our volunteer opportunities, please tell us about yourself and feel free to answer only those questions that apply to you. 

I. Contact Information

First Name *
Last Name *
Month
/
Day
/
Year
Country
Address Line 1 *
City *
State/Province *
Postal Code *
No Email:

Phone Numbers

EMERGENCY CONTACT INFORMATION

First Name *
Last Name *

II.    Professional Experience

Volunteer Experiences and Interests:

Please tell us about any past volunteer experiences that you may have had.

Our volunteers bring many diverse talents and backgrounds to Dress for Success Dutchess County. Below are just a few examples of how you can get involved. Please check off any or all areas of interest. Feel free to add to the list below!

When are you available to volunteer?
Are you willing to travel within Dutchess County/Hudson Valley for special events?
Would you be able to work evenings?
Do you prefer to volunteer on the same day each week or month?

How many hours a week / month are you available?

Or do you prefer volunteering on a floating/as needed basis?

Agreement and Signature

This agreement applies to all volunteers associated with and/or involved in the activities or affairs of Dutchess Community Action Agency, Inc (“DCCAA”). This includes all activity associated with DCCAA at its main office and all outreach sites locations.

All data, materials, knowledge, and information generated through, originating from, or having to do with DCCAA or persons associated with our activities, including contractors, is to be considered privileged and confidential and is not to be disclosed to any third party. All pages, forms, information, designs, documents, printed matter, policies and procedures, conversations, messages (received or transmitted), resources, contacts, e-mail lists, e-mail messages, client, staff or public information is confidential and the sole property of DCCAA.

This also includes, but is not limited to, any information of, or relating to, our staff, clients, operations and activities. This privilege extends to all forms and formats in which the information is maintained and stored, including, but not limited to hardcopy, photocopy, microform, automated and/or electronic form.

Client information, including all file information, is not be disclosed to any third party, under any circumstances, without the consent of the DCCAA employee that is supervising you and the Executive Director.

Any disclosure, misuse, copying or transmitting of any material, data or information, whether intentional or unintentional, will subject you to disciplinary action and/or prosecution, according to the procedures set by DCCAA and any applicable laws.

New York applicants: All pending arrests or criminal accusations must be disclosed. You are not required to disclose arrests or criminal accusations that resulted in criminal actions or proceedings which were terminated in your favor. Do not disclose criminal actions or proceedings that were sealed or classified as youthful offender adjudications. An ex-offender who is denied employment may, upon written request, receive a statement of the reason)s) for denial within thirty (30) days of the applicant’s request for such information.

Have you ever plead guilty or no contest to, or been convicted of any criminal offense other than the applicable exceptions listed above?
Have you ever been arrested for any matters for which you currently are out on bail or on your own recognizance pending trial?

CRIMINAL OFFENSES ONLY: If you answered Yes, to either of the above two questions, please provide the date(s) and explain in accordance with the above instructions so that individual circumstances can be considered.

Criminal convictions or arrests will not automatically disqualify an applicant from a particular job. The Company will consider the nature of the crime, its seriousness, the substantial relation to the position’s functions and qualifications, the number of occurrences, the applicants age at the time of the crime, the time elapsed since the crime. The applicants entire work and educational history, employment references and recommendations and the business necessity of any exclusion when required by law.

Have you ever initiated an act of violence in the workplace?

If yes, please provide the date(s) and explain so that individual circumstances can be considered. (A “Yes” answer will not necessarily disqualify you from employment)

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 my immediate dismissal. My signature signifies I agree to these terms and will abide by, adhere to and honor all of the above.

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