Volunteer Application

  • (Please do not list relatives)
  • I understand that in the performance of my duties on behalf of Eastern Area Agency on Aging, I will have access to sensitive information about the client I am serving, and that such information may include medical, insurance, financial, and other sensitive and confidential personal information. I agree to restrict my use of such information to the performance of my duties as a volunteer of Eastern Area Agency on Aging. I agree I will not discuss cases or mention client(s’) names, or otherwise reveal or disclose information pertaining to any client, except within department rules and regulations. Information will only be released to or shared with Agency on Aging staff, and/or those persons/agencies/businesses that the client (or his/her legal representative) has expressly given permission to do so – and then only for the purpose of assisting the client. I also agree that I will provide my full name, position with the agency and the purpose of obtaining the information on behalf of my client. I hereby acknowledge my obligation to respect the client’s privacy and the confidentiality of the information pertaining to the client, and to exercise good faith and integrity in all dealings with the client and his or her personal information in the performance of my duties as an employee of Eastern Area Agency on Aging. I also understand that any unauthorized use or disclosure of information about or pertaining to a client may result in disciplinary action by Eastern Area Agency on Aging, and may subject me to civil liability for breaching the client’s right to privacy. I also understand that any willful and knowing false representation, for the purpose of obtaining information from those agencies and businesses whose records are subject to the Privacy Act, may be criminally prosecuted.
    To help us assign you to a position that you will most enjoy, please look over the following choices below and select those that would interest you.