L I N C O L N G L E N: A CARING COMMUNITY FOR SENIORS
Address
2671 Plummer Avenue
San Jose, CA 95125
Telephone and Fax Numbers
Phone: (408) 265-3222
Fax: (408) 265-2839
Dear Prospective Volunteer,
Thank you for your interest in joining the Lincoln Glen Community! As a volunteer you can be part of the lives of our residents and learn from them too!
Answers to Common Questions:
Volunteers work with the Community Life/Activities Department and may:
--Assist with Group Activities
--Present an activity or program
--Share a talent or skill
--Visit with residents individually
--Help residents with computers and Wii
--Decorate the facility--Work with residents on special projects
How much training is required to become a volunteer?
You must participate in a one hour orientation session with a member from the
Activity Department.
Is there a minimum time commitment for volunteering?
We can accommodate the time commitments required by most school-based service
programs.
We also appreciate and value one time/project-oriented volunteers. Individual
time commitments and scheduling can be discussed during your interview.
Do I do any direct care?
Volunteers with the Community Life/Activities Program do not do any direct care
(Le. taking a resident to the restroom or helping someone get into or out of
bed). This will be further discussed in the orientation/training session.
1. Complete the volunteer application.
2. Obtain parental consent signatures (if under age 18).
3. Sign confidentiality and abuse prevention statements.
4. Provide a copy of your TB Skin Test verification if you have had it done
within the past year. We will provide this test if needed.
5. After you return your completed application, the Activities Director will
contact you to schedule an interview.
In an email or letter, please provide following information:
Last Name
First Name
Phone Number
Email Address
Date of Birth
Current Occupation
Previous Work or Volunteer Experience
School (currently attending) and Grade in school
Special Hobbies or Interests
How did you learn about our program?
Why are you interested in volunteering with us?
Have you had any prior experience with elders? Please describe that experience.
Have you ever been arrested?
Which of the following activities would you like to help with? Please list the activities you choose.
Assist with Group Programs:
Active Games
Arts and Crafts
Birthday Parties
Exercise Classes
Holiday/Festive Parties
Gardening
Word games or Table games
Reading Current Events
Religious Programs
Sensory Group
Individual Visits:
Conventional visits
Computers IPad
Current events
Letter writing
Reading aloud
Reminiscing, looking at pictures
Sensory stimulation
Table games, cards
Trivia
Special Projects
Bring a pet to visit
Decorating for Parties
Decorating halls
Music or dance recital
Leading art or craft classes
Prepare for special events
Bring children to visit
Please print, complete, sign and bring the completed Emergency Contact Persons Statement, the Parental Consent Statement if you are under age 18, the Volunteer Staff Confidentiality Statement, the Abuse Prevention statement and the Parental Consent for the Tuberculosis Skin Test if you are under age 18 to your orientation meeting. If that is not possible, please ask the Activities Office staff to provide you with a copy of the forms and help to complete them when you arrive at the orientation.
Name of First Emergency Contact Person _________________________________________________
Relation:_____________________________________________________________________
Phone Number:_______________________________________
Name of Second Emergency Contact Person_______________________________________________
Relation:______________________________________________________________________
Phone Number:_______________________________________
PARENTAL CONSENT FORM FOR ANY VOLUNTEER 18YRS. OF AGE OR YOUNGER
I, _______________________________________________give permission for
___________________________________, who is my_______________________, to complete Volunteer work at Lincoln Glen
Nursing Facility Assisted Living Facility.
Step 3. Sign confidentiality and abuse prevention statements.
VOLUNTEER STAFF CONFIDENTIALITY STATEMENT
I,_________________________________________________, hereby agree to regard all information received in the performance of my volunteer work in this health care facility as confidential.
I understand that this facility respects residents’ rights with regard to
privacy of information, and I agree to respect these rights in the performance
of my volunteer duties and keep “professional” confidentiality in all my
statements outside the facility. I will not speak about residents outside of the
facility to anyone.
I agree to respect the residents’ rights to privacy, as well as those of the
family and the facility whenever I make community presentations or participate
in volunteer recruitment programs. The content of these presentations will be
approved in advance by the Activities Director.
Volunteer Applicant ___________________________________________________
Signature____________________________________________________________
Date___________________
I,_________________________________________________, hereby agree to adhere to the Abuse Prevention Program of Lincoln Glen Nursing Facility, Assisted Living Facility. I agree to immediately report any abuse or suspected abuse to the Activities Director.
Volunteer Applicant __________________________________________________
Signature____________________________________________________
Date___________________
Step 4. Get a Two-Step TB Test and Flu Shot. Flu Shots are required for ALL volunteers during Flu Season. (Attach verifications to your applications.)
I,_________________________________________________, give permission for
_______________________________________who is my
______________________________, to have a “PPD” test done at Lincoln Glen Nursing Facility
Assisted Living Facility.
Print Name___________________________________________________
Signature____________________________________________________
Date__________________________________
Step 5. Attend Orientation and learn the best ways to work with residents! Please call
(408) 265-3222 to schedule a time, or call for upcoming dates.
Please remember to bring your signed statements to the meeting.