Volunteer Application Form

In the event of an emergency, please notify the following:

I hereby sign that all of the above information is true and accurate. Any false information will result in termination of my volunteer services.

If you need reasonable accommodation to participate in the volunteer process or perform volunteer activities, you may contact Human Resources at 716-684-3000 ext. 1317. Requests for accommodation are handled separately from this form and from volunteer selection decisions.

If selected for a volunteer opportunity, you may be required to complete additional items in accordance with applicable laws and facility requirements, which may include:

• K-checks e.g. sex offender, Medicaid and Medicare fraud (in accordance with the Fair Credit Reporting Act)
• Review under New York Correction Law Article 23-A
• Health screening (including physical, PPD, and/or drug testing, as applicable)
  • These requirements are conducted in compliance with New York State regulations governing nursing homes, assisted living, and rehabilitation facilities.

I hereby sign that all of the above information is true and accurate. Any false information will result in termination of my volunteer services. I understand that:

• Providing this information is voluntary
• I am not required to answer any questions
• My responses will be kept confidential and maintained separately from my volunteer applications
• This information will not be used in any decision regarding my eligibility for a volunteer position