Legal Aid Society of
Orange
County
VOLUNTEER/INTERN
INTAKE SHEET
I am a(n):
q Community Member q Attorney q Legal
Analyst
q Paralegal
q Legal Secretary
q Law Student (School and Anticipated Date of Graduation): ___________________________________
q College Student (School and Anticipated Date of Graduation):
_________________________________
q HS Student
(School and Anticipated Date of Graduation):
___________________________________
Please check one:
q Volunteer
q Intern
Last Name:
__________________ First Name _______________________ Middle Initial _____
Employer (if applicable): ________________________________________
Title: _____________________
Mailing Address:
_________________________________________________________________________
City :
_______________
State : _____
Zip: __________
Telephone 1:
(___) ____ - _____ Telephone 2: (___)
____ - _____
E-mail address:
________________________ Fax Number:
(___) ____ - _____
My preferred method of communication
is by (check all that apply:) q
Telephone q
E-mail
Do you consent to having your LASOC
volunteer status made public?
q Yes
q
No
Emergency Contact
(required):
Name: _________________________ Relationship:
________________
Phone Number:
__________________________ Address: ________________________________
How did you hear about this volunteer/internship opportunity?
q Referral
q Community
Event q Website
(Please specify:) _______________ q Other
____________
Does your employer have a volunteer program?
q Yes q No
Have you ever worked/volunteered/interned with LASOC before? q Yes
q No
If yes, when?
_______________
CONFLICTS: Do you have
any business, family or personal obligations (not including time availability that
could conflict with volunteering with LASOC?
q Yes q No
Are you or, to the best of your knowledge, is any immediate
family member currently a party to litigation in
California ? q Yes
q No
Have you, or to the best of your knowledge, has any immediate
family member been a party to litigation in
California during the past two years?
q Yes q No
Do you, or to the best of your knowledge, does any immediate
family member plan to file a lawsuit in
California ? q Yes
q No
If you answered yes to any of the above, please explain
on a separate sheet of paper.
REQUIRED SERVICE:
Are you volunteering or interning
to fulfill a requirement of any program?
This includes internships for school credit or stipend.
q Yes q No
If you answered yes, please provide a written statement
from the program detailing all requirements for both you and for LASOC.
We must have this statement before we can process your application.
FELONY/MISDEMEANOR
CONVICTIONS:
Have you ever been convicted of a felony or misdemeanor?
(You do not have to report arrests not followed by convictions or convictions
which were annulled, sealed or expunged.)
q Yes q No
If you answered yes, please explain on a separate sheet
of paper, listing the date and charge(s).
SKILLS: (Check all that
apply):
q Administrative (Data Entry, Filing, etc.)
q Legal (Research, Analysis, Writing, etc.)
q Marketing/Public Relations
q Special Events/Fundraising
q Speaking/Outreach
q Technology (Web, Computer Skills, Graphic Design, etc.)
q Language(s) Spoken:
__________________
q Other Special Skills:
_________________________________
_________________________________
q Language(s) Translated:
_________________________________
AREAS OF INTEREST:
(Check all that apply):
q Domestic Violence Program (Compton
and
Norwalk )
q Consumer Issues
q Employment Law
q Family Law
q Government Benefits
q Health Law
q Landlord-Tenant Law
q Civil Defense
q License Suspension
q Elder Law
q Tax Law
q Small Claims Advisory Program
q
Legal
Resolutions
Center
AVAILABILITY: (Please state
specific times and days you would like to volunteer/intern.)
How many hours
would you like to volunteer/intern? __________ (Circle one:
per week, per month, per year)
I can volunteer for approximately ______ weeks beginning
_________ / __________.
(Month)
(Day)
|
Day
|
Hours Available
|
|
Monday
|
|
|
Tuesday
|
|
|
Wednesday
|
|
|
Thursday
|
|
|
Friday
|
|
|
Saturday
|
|
WRITTEN STATEMENT:
Please attach a separate written statement or cover letter that explains what
you hope to accomplish, gain or learn from volunteering with LASOC, or what you
hope to contribute to LASOC. Please
limit your statement to one page, 12 pt. font, single spaced.
Thank you.
I certify that all statements made on this application and
on my resume are true.
_______________________________ _________________
(Volunteer’s/Intern’s Signature)
Date
Internal:
Received by LASOC Staff: ________________________ Date:
________
(Staff Signature)
Legal Aid Society
of
Orange
County
VOLUNTEER/INTERN
CODE OF CONDUCT AND CONFIDENTIALITY AGREEMENT
I, ______________________________, as a/n (circle one: volunteer / intern) of the Legal Aid Society
of Orange County (LASOC), agree to the following conditions:
I.
VOLUNTEER/INTERN CONDUCT
1.
While working as a volunteer/intern, I am required to
refrain from using any substance, alcohol or drugs which impairs my ability to act
in the best interests of LASOC and/or its employees, clients and guests.
Violation of this condition is reason for dismissal.
2.
I understand that LASOC does not practice, condone, facilitate
or collaborate with any form of discrimination on the basis of race, color, sex,
religion, mental or physical handicap, marital status, sexual orientation or personal
characteristics and circumstances.
I agree to refrain from all forms of discrimination.
3.
I agree not to act as a spokesperson for LASOC, or to
speak to the media on behalf of LASOC unless authorized, for a specific purpose,
by an authorized staff member of LASOC.
4.
I agree to bring any problem with a client, which is beyond
the scope of my volunteer/intern expectation or ability, to the attention of the
volunteer/intern coordinator or staff partner.
5.
I agree to abide by any policies and procedures established
by LASOC which may be more specific in nature to my volunteer/intern responsibilities,
or approved after the signing of these initial policies.
6.
I understand that any access code, password, etc. assigned
by LASOC will be kept confidential.
II.
CONFIDENTIALITY
1.
I understand, in the course of my work for LASOC, that
I may learn certain highly personal and confidential facts about persons, clients,
individuals and/or entities who/that are served by LASOC.
Examples of such information are income and tax information, living arrangements,
employment, relations with family members and the like.
I understand that all such information, including the identity of any persons,
clients, individuals and/or entities, must be treated as completely confidential
and will remain confidential even after I terminate my volunteer/intern service
with LASOC.
2.
I agree not to disclose any information of a personal
and confidential nature to any person not also affiliated with LASOC and authorized
by LASOC to have such information, without the: a)
specific consent of the individual to whom such information pertains and b) prior
knowledge and approval of LASOC.
3.
I further agree that if I become aware of a breach of
confidentiality by another LASOC volunteer or intern, I must immediately report
such breaches to the volunteer/intern coordinator or staff partner, along with the
name of the volunteer or intern and the client involved.
4.
Failure to comply with these terms of confidentiality
will result in my release from volunteer/intern service with LASOC and possible
legal action under the laws of the State of
California and other jurisdictions.
III.
LASOC AGREES TO:
1.
Provide adequate training and orientation for volunteers/intern
in LASOC’s procedures, policies and organization.
2.
Provide a person to coordinate volunteer/intern activities,
training, evaluation and respond to volunteer/intern issues and grievances.
3.
Keep a personnel file on each volunteer/intern, including
information sheets, time cards, signed statements, and other confidential materials,
which would be available to the volunteer/intern by arrangement.
4.
Serve as a reference upon request.
I hereby acknowledge that I have read and understood the
Volunteer/Intern Code of Conduct and Confidentiality Agreement outlined in this
document. I further understand that
my capacity as a volunteer/intern is without compensation and/or benefits.
I understand LASOC may change these volunteer/intern policies at any time
and that I will be notified of such change.
BY: VOLUNTEER/INTERN
________________________________
Please Print Your Name
________________________________
Volunteer/Intern Signature
_______________________________
Date
BY: LEGAL
AID SOCIETY OF
ORANGE
COUNTY
________________________________
By:
________________________________
Signature
_______________________________
Date