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The Employment section and any Supplementary Experience Form(s) must be completed. A resume may be attached, however “See attached resume” is not acceptable and application will be considered incomplete. Starting with your most recent relevant employment, please describe all paid, military and or applicable volunteer experience. Describe those duties and responsibilities that best demonstrate your qualifications for this position.
Please list three (3) persons (not a relative) we may contact regarding your qualifications, character, and reliability. At least one reference must be a Supervisor or Professor. Student Interns must provide information about school faculty or staff making the referral.
1. I acknowledge the important responsibilities involved in working with children and adult clients. Norfolk Department of Human Services determines the suitability of all paid and non-paid employees through drug screenings, child protective services, and criminal background checks. It is our policy to treat all non-paid employees with the same consideration awarded to paid employees. A Criminal Background, Child Protective Services check and drug screen will be performed prior to starting my internship or volunteering.
2. I hereby authorize the individuals and organizations listed on the Norfolk Department of Human Services Non-Paid Employee Program Application to furnish information concerning me to Norfolk Department of Human Services as requested on this reference form.
3. I understand that Norfolk Department of Human Services is a drug free workplace and that using or being under the influence of illegal substances or alcohol while volunteering is grounds for termination.
Norfolk Department of Human Services volunteers, student interns, and employees have a primary obligation to safeguard information about individuals obtained in the course of teaching, practice, or research. Personal information is communicated to others only with the person's written consent or in those circumstances where there is clear and imminent danger to the client, to others, or to society. Disclosures of counseling information are restricted to what is necessary and relevant.
a. The client has the right to decide what information may be shared with anyone beyond the immediate provider of services and to be informed of the implications of the materials being shared.
b. The anonymity of clients served in public and other agencies is preserved, if possible, by withholding names and personal identifying data. If external conditions require reporting such information, the client and Norfolk Department of Human Services shall be so informed.
c. Information received in confidence by one agency or person shall not be forwarded to another person or agency without the client and Norfolk Department of Human Services’ written permission.
d. Case reports presented in classes, professional meetings, or in publications shall be so disguised that no identification is possible unless the client or responsible authority has read the report and agreed in writing to its presentation or publication.
e. Case Management documents and records are maintained under conditions of security and provisions are made for their destruction when they have outlived their usefulness. Human Services professionals insure that privacy and confidentiality are maintained by all persons in the employed or volunteer services of the agency or office, including clerical staff, interns, volunteers, and community aides.
f. Norfolk Department of Human Services’ volunteers, student interns, or employees who ask that an individual reveal personal information in the course of interviewing, testing, or evaluation, or who allow such information to be divulged, do so only after making certain that the person or authorized representative is fully aware of the purposes of the interview, testing or evaluation and of the ways in which the information will be used.
g. Sessions with clients are taped or otherwise recorded only with their written permission as well as the written permission of Norfolk Department of Human Services. Even with the guardian’s written consent, one should not record a session against the expressed wishes of a client.
h. In working with families, the rights of each family member should be safeguarded.
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