Volunteer Application for Community Action House





Primary Phone

Primary Address

What are you interested in?


Do you have Court-Ordered Community Service?

If so, please state the number of number of service hour required.


We do not currently have evening hours later than 6 pm.

Other Skills:

Please tell us about any skills you have that you would like us to know about.

Areas of Interest

Please check off the Volunteer Positions that are you interested in.

Do you have any limitations that require accommodations?

How did you hear about us?


Emergency Contact

Background Check Information

Notification: Community Action House requires me to consent to a criminal background check as a condition of volunteering. This check includes the following:

• Criminal history reference searches for felony and misdemeanor convictions at the county, state, and federal levels in every jurisdiction where I currently reside or have resided during the past 7 years;
• Sex offender registry searches at the county, state, and federal levels in every jurisdiction where I currently reside or have resided.

I hereby authorize Community Action House (CAH) to conduct the criminal background check described above. In connection with this, I also authorize the use of law enforcement agencies and/or private background check organizations to assist CAH in collecting this information. ICHAT will be used as a third party vendor to assist CAH in collecting and verifying information.

To the best of my knowledge, the information provided in this Notice and Authorization and any attachments thereto is true and complete. I understand that any falsification or omission of information may disqualify me to volunteer at Community Action House.


By clicking "I agree" below, I hereby provide my authorization to CAH to conduct a criminal background check. I understand that I have a right to appeal an adverse decision made by CAH based on my background check information within three business days of receipt of such notice and that a determination on my appeal will be made in seven working days from CAH's receipt of such appeal.

Please enter your Full Legal Name




For background check purposes, please select ONE option, as it appears on your government issued I.D.:


For background check purposes, please select ONE option as it most pertains to you:

List any other names you've used in the past seven years:


Have you ever been convicted of a criminal offense or have any pending criminal charges against you?

If yes, please provide detail below.

Volunteer Guidelines

Thank you for your willingness to volunteer your time and talents. As members of the Community Action House team, we ask our volunteers to agree to these guidelines:

• All volunteers must pass a background check before they can volunteer, for the safety of all of our volunteers, clients, and staff.
• Discuss your availability and schedule with the site supervisor.
• Sign the volunteer log each time you volunteer. This information is for statistical purposes and for some of our grants.
• Respect the diversity of clients, volunteers, and staff at CAH. Please treat all individuals with respect regardless of race, ethnicity, sexual orientation, religion, age or gender.
• People donate to support CAH programs and the people we serve. You may not take any donated items unless pre-approved by CAH staff.
• If you are unsure about a task, don’t hesitate to ask for additional information.
• Respect the privacy and workspace of others.
• Wear appropriate clothing for your tasks. Examples: clothing for safety and health, clothing not offensive to others.
• Always adhere to the CAH confidentiality policy.
• If you are ill or have an emergency and cannot volunteer at your scheduled time, please contact the appropriate location and site supervisor.

Confidentiality Policy

In all Community Action House programs, care must be taken when discussing guests' matters internally, within the office setting, and over the telephone to protect privacy and to maintain confidentiality.

Sharing of guests' information must be limited to that which is needed for verification of important client information or relevant to addressing a particular guests' need. Information should only be shared while the guest is present after receiving their verbal consent, or, if the guest is not present, only after receiving written authorization from the guest (using the ‘Release of Information’ form and/or the ‘Intake’ form).

Guests' records and documents containing sensitive data will be maintained in a secure area in a manner which is not accessible to other guests, visitors, or other volunteers.

All agency volunteers who have direct access to guest data must sign the second page of the volunteer information form acknowledging receipt of, and agreeing to compliance with, this confidentiality policy.

Receipt & Acknowledgement

By checking "I Agree" below, I acknowledge receipt and understanding of the Volunteer Guidelines and Confidentiality Policy.
• I have read and agree to follow the Volunteer Guidelines.
• I am willing to protect the confidentiality of all individuals who have requested or are receiving services from Community Action House.
• I agree that I will not disclose or discuss information regarding any guest to any unauthorized person or organization.
• I have read and agree to follow the Community Action House Confidentiality Policy.
About Community Action House
Fighting Hunger | Providing Connection | Increasing Financial Wellness Our Mission: Provide area families and individuals with food, clothing, shelter and the opportunity to build necessary skills to achieve a stable and prosperous life Serving the greater Holland community since 1969
Visit hub
Community Action House logoCommunity Action House