Our Mission:
“To strengthen our community by enhancing the quality of other people’s lives through the delivery of goods and services to those in need.”
VOLUNTEER APPLICATION
DATE:
NAME:
ADDRESS:
PHONE:
AGE :
BIRTH DATE:
GENDER: Male
SOCIAL SECURITY NO.:
Female
EDUCATION ( Check the last grade completed) :
Grade School 1 2 3 4
Required for Background Check
5 6 7 8
High School 9 10 11 12 GED or Other HS Equivalency
College 1 2 3
Degree or Field of Study:
4
Graduate School 1 2 3 4
Degree or Field of Study:
CURRENT OCCUPATION:
Other:
Other:
2100 N. Nimitz Highway Honolulu, HI 96819 Ph: 536-7234 Fax: 536-7236

CURRENT EMPLOYER:
PREVIOUS PAID EXPERIENCE:
PREVIOUS VOLUNTEER EXPERIENCE:
ARE THERE ANY CIRCUMSTANCES THAT WOULD LIMIT YOUR ABILITY TO
VOLUNTEER WITH HELPING HANDS HAWAII?
(Please be specific – i.e. Health, etc.)
ANY SPECIAL HOBBIES OR SKILLS YOU HAVE THAT YOU MAY WANT TO SHARE
WITH US:
CLERICAL SKILLS
(Please be specific- i.e. Microsoft Office, Excel, etc.)
WHY ARE YOU SEEKING A VOLUNTEER POSITION WITH OUR AGENCY
(Please be specific – i.e. Internship for school, First to Work requirement, etc.)
AVAILABILITY
(Please write in the times that you are available to volunteer in the space provided. Please note that our agency is closed on weekends and on most major holidays .)
Morning
Monday Tuesday Wednesday Thursday Friday
(8 a.m. to
12:00 p.m.)
Afternoons
(12:00 p.m. to
4:30 p.m.)
IS THERE A SPECIFIC NUMBER OF VOLUNTEER HOURS THAT YOU WILL BE
REQUIRED TO COMPLETE?
Yes (Number of Hours: )
No (How long do you plan to volunteer with HHH? )
IS THERE SPECIFIC PAPERWORK FOR SCHOOL OR OTHER THAT WILL NEED TO BE
COMPLETED BY HHH STAFF IF YOU ARE SELECTED TO VOLUNTEER?
Yes (If Yes, please bring paperwork to interview)
No
CAN WE CALL YOU FOR SHORT-TERM/SEASONAL ASSISTANCE, AS NEEDED?
Yes No
DO YOU HAVE ACCESS TO A RELIABLE VEHICLE?
Yes No
HHH OFFERS A NUMBER OF PROGRAMS TO SERVE OUR LOCAL COMMUNITY.
PLEASE SELECT THE PROGRAM THAT YOU ARE MOST INTERESTED IN
VOLUNTEERING WITH
(You may select more than one, but please indicate the preference of which most program you would be most interested in volunteering with).
2100 N. Nimitz Highway Honolulu, HI 96819 Ph: 536-7234 Fax: 536-7236

Administration – Provide clerical and filing support for Human Resources,
Accounting, & Other Administrative Sections within the agency. Includes making xerox copies, shredding documents, basic data-entry and other light clerical tasks. May include front desk and reception duties.
Client Intake Assistance – Provide assistance to the Emergency Assistance
Program (EAP) and Supplemental Nutrition Assistance Program (SNAP).
Volunteers will interact with clients to aid and assist in the thorough completion of applications to expedite benefits to those who need them.
Community Clearinghouse Warehouse – The Community Clearinghouse
(CCH) warehouse receives donations of clothing, furniture, and basic household items from the public and distributes these items to over 2,500 low-income households each year. Volunteers assist with sorting and receiving donations, greeting donors and clients, and maintaining the cleanliness of our warehouse facility.
Community Clearinghouse Office – The CCH office schedules requests from donors for donation pick-up service, schedules clients for appointments to visit the donation warehouse, and files client applications for material and financial assistance. Volunteers assist with answering telephone calls, filing paperwork, and checking in clients who receive items from the donation warehouse.
Representative Payee Program – The Representative Payee program assists
Seriously Mentally Ill (SMI) individuals receiving government entitlements, such as Social Security or Veterans Administration benefits, with managing their finances. Volunteers assist with clerical duties, including filing and data-entry, to support the program operations.
Behavioral Health Division – The Behavioral Health Division provides
Community-Based Case Management (CBCM) and Access to Recovery (ATR) services to SMI individuals referred by the Department of Health – Adult Mental
Health Division. Volunteers assist with clerical duties, including reception, filing, and data-entry, to support the program operations. (If you are applying for a practicum/clinical, you will need to have malpractice insurance either through your school or as an individual).
HOW DID YOUR HEAR ABOUT HELPING HANDS HAWAII’S VOLUNTEER
PROGRAM? (Please be specific. i.e., if you were referred by a friend, who?)
HHH Website Aloha United Way
Department of Human Services Other
School Family / Friends
2100 N. Nimitz Highway Honolulu, HI 96819 Ph: 536-7234 Fax: 536-7236

CONFIDENTIALITY AGREEMENT
Helping Hands Hawaii
As an employee/volunteer/Practicum student, I agree that:

I will not divulge, in casual conversation, the location of the CBCM program, ATR
Program, or other Behavioral Health programs.

I will not divulge any confidential information pertaining to Helping Hands Hawaii’s staff.
 I understand that all communication between the agency’s staff and any clients are privileged confidential discussions and are not to be discussed with anyone who has not signed this document.

I understand that all cases are of a confidential matter and are not to be discussed with anyone who has not signed this document.

Should I ever encounter a CBCM, ATR, Behavioral Health, HPRP client, or any persons who have used Helping hands Hawaii services in my own personal life, I will not divulge my awareness of his/her status with the Agency.
____________________________________________ ________________
Signature Date
_______________________________________________________________
Name (please print)
2100 N. Nimitz Highway Honolulu, HI 96819 Ph: 536-7234 Fax: 536-7236