Application for Voluntary Service

Camphill Association of North America Coworker Application Form USA

What is your name?

(Last/Surname) (First/Given Name) (Middle Name)

What is today's Month Day Year date?

What is your current address? (All information will be sent to this address unless you notify us of a change.)

Phone Fax Email

What is your nationality?

(For US citizens) What is your social security number?

What is your date of birth? Month Day Year

What gender are you? Male Female

What is your desired term of From: To: Year? service? (Nominate month and year.) What is your earliest starting Day Month Year? date? Please note that priority will be given to applicants who can commit to our desired term of service.

Camphill Association of North America – Application Form USA 6/27/2018 Education Our admissions committee is interested in your educational, practical and personal development. Please provide details of all relevant training.

Grade Location Dates attended High School (Yrs 9-12)

College / University (Name your area of study here.)

Other training (Name your area of study here.)

Community Service We are interested to learn how you have been active in community service, social action groups, and support for individuals with a disability or some other need.

Please tell us why you decided to get involved, and what you received in return — what did you learn? Your involvement could include supporting an individual, contributing in your neighborhood, school, youth group, religious organization, social, professional, land care, volunteer groups etc

Activity / Organization (Where From To possible, provide contact name and details (phone/fax/email)

Camphill Association of North America – Application Form USA 6/27/2018 Prior Camphill Experience Have you visited, lived or worked in a Camphill community before? If so, please provide details.

Name of community (Where From To possible, provide contact name and details (phone/fax/email)

Employment History Please provide details of the duties and responsibilities you were given in the positions in which you were employed. List the most current position first. (Attach a resume, if desired.)

Name of organization From To Duties and responsibilities and employer

Camphill Association of North America – Application Form USA 6/27/2018 Skills and Experience Please list skills, experiences and talents that you would bring with you. For instance: people support and care skills, practical skills, administration, technical, homemaking, cooking, landcare, musical, artistic, writing, teaching etc.

Skill / talent / experience (Explain how you might contribute to the community.)

Motivation and Goals

Why do you want to join Camphill community?

What do you hope to gain? Please describe two or three specific goals that you would like to work toward during your experience at Camphill.

Autobiography

Please discuss ways in which your experience and background have influenced your decision to volunteer in Camphill. We are interested to read a chronological account of your life, including references to family background/situation, significant experiences, (for instance, encounters with significant people, community living experiences, illnesses), as well as any other details you consider relevant.

We would appreciate your account of an experience and event in your life which had a successful outcome, and what you learned from this.

Camphill Association of North America – Application Form USA 6/27/2018 Similarly, we would like you to tell us of an event in your life whose outcome you did not experience as successful, and what you learned from this.

Future / Vocation Studies

What is your current thinking about future vocation and studies?

How do you see your Camphill experience furthering these goals? (It is OK if you are not sure.)

Family Members Please list the names of family members also applying to join Camphill, if any.

Relationship First name Last name Date of birth

Financial Obligations Do you have obligations to pay outstanding or ongoing debts?

Yes No Indicate amounts ($) Do you have children who rely on you for financial support? Do you have outstanding loans / financial commitments?

Finding Camphill

Camphill Association of North America – Application Form USA 6/27/2018 How did you learn about Camphill?

Have you applied to any other Camphill communities? (If yes, this will not disqualify you from applying here. But please provide details of where and when, as we need to know if you are pursuing an application elsewhere. We rely on our volunteers.)

Obtaining a Visa This only applies to international applicants. This information is essential to your application for a visa to live in the United States.

Passport number Expiry date

Name as it appears on passport Country of citizenship

Country of birth City of birth

Country of legal permanent residence

Position and/or level of training in home country

If English is not your first language, what is your Excellent Good Fair Limited fluency in the language? (Tick one of the following:)

References Please provide the name, address, and contact details of 3 people we may contact for references. Please indicate their relationship to you.

Referee / relationship to you Contact details

Please give the reference form attached to each referee, to fill in and return.

Camphill Association of North America – Application Form USA 6/27/2018 Pre-Service Agreement

I certify that all statements I have made on this application, or in any attachments provided by me, are true.

Health Documentation I understand that if I am accepted as a co-worker, I must provide the following materials no later than four weeks before my scheduled start date, and that my final acceptance is contingent upon Camphill Communities California receiving: 1. A medical certificate stating my current health condition, current treatments, and past medical history 2. A dental certificate stating my current dental condition 3. Evidence of health insurance coverage (a valid health insurance policy/certificate showing comprehensive coverage)

I also understand that I am solely responsible for any dental work that may be required during my period of service or thereafter.

Benefits I understand that as a volunteer at Camphill, I will be provided with my own room and board in a house community, where I will be living with other community members including people with disabilities whom I will be expected to support. I understand that I will receive a monthly stipend to cover personal expenses. I also understand that Camphill California does not cover the costs of transportation to and from the community.

Abuse Policy I understand that Camphill offers a safe and open community environment for a vulnerable group of people, and that special precautions must be taken to ensure the safety of the people it supports. I understand that abuse of any kind — violence, harassment, any form of sexual abuse, emotional abuse — is considered a criminal offense and will not be tolerated. I understand that such behaviors will result in immediate suspension/dismissal. I understand that I will be required to participate in orientation, education and training at Camphill about abuse and abuse prevention.

US citizens I hereby give my consent to Camphill to activate a criminal background check on my behalf with ‘Volunteer Select’ — a Federal background check service (see www.volunteerselect.com for more information)

International applicants I understand that I must obtain and forward to Camphill a Federal background check from the police department in my country of residence, when I send my health documents.

I understand that if I am accepted for a service position, Camphill will send me appropriate visa forms. I understand that I am responsible for making an appointment with the US consulate in my country to present the forms. If my visa application is denied, I understand and accept that Camphill Communities California is unable to take any further action on my behalf.

Camphill Association of North America – Application Form USA 6/27/2018 Drug and Alcohol Policy I understand that Camphill forbids any co-worker to be under the influence of recreational drugs and alcohol while serving at Camphill. I understand that engagement with recreational drugs and alcohol will not be tolerated and may result in immediate suspension/dismissal.

Support documents I understand that although my application may be conditionally accepted, if Camphill does not receive any one of the required documents, or if the materials disqualify me from serving in any way, Camphill reserves the right to reverse its acceptance decision.

I understand that Camphill Communities California retains sole discretion in deciding a volunteer’s ability to fulfill the expectations of the service description.

Applicant’s Signature (When you write your name above, this certifies as your signature and approval to the Pre-Service Agreement.)

Camphill Association of North America – Application Form USA 6/27/2018