Fillable Va Form 0926j - Volunteer Application (Page 3 of 3) in pdf

Va Form 0926j - Volunteer Application Page 3

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I understand and agree to abide by the following factors which have been discussed with me: volunteer rights and responsibilities,

reporting hours, fire/safety rules and regulations, reporting of special incidents, infection control, blood borne pathogens, hazard

communication, equipment and utility management, and confidentiality.

I hereby waive all claims to monetary benefits for services rendered as a volunteer worker on a "without compensation basis" for an

indefinite period. I understand that this waiver applies only to remuneration (compensation) for specific services rendered in the

Voluntary Service (VAVS) Program and is not related to any other VA services or benefits to which I may be entitled. (NOTE: VA has

entered into this agreement by the authority of 38 U.S.C., Section 513. This agreement may be cancelled by either party upon written

notice.)

FOR VA EMPLOYEES: I further understand that I will be granted authorized absence during my regular work schedule (after

appropriate request has been submitted to supervisor and approved). Hours worked beyond the normal workday or on weekends will

be considered strictly volunteer hours and I understand that I will not be paid overtime, compensatory time, premium pay or differential

pay.

I voluntarily and without compensation authorize pictures and/or voice recording to be made of me by or on my behalf of VA, HHV,

VCS, US military publications, and other magazines, veterans' publications, newspapers, and broadcast media, etc. while I am a

volunteer in the National Veterans Golden Age Games. I authorize any or all of the above to publicize and/or display such

photographs and recordings, or to provide such photographs and recordings to others of their choosing for display, without notice or

payment of any royalty, fee, or other compensation of any character to me for the use of my picture and/or voice. I understand that the

said pictures and/or voice recordings are intended to publicize and give recognition to the National Veterans Golden Age Games.

VA FACILITY REPRESENTING

SIGNATURE OF EMPLOYEE VOLUNTEER

DATE

SIGNATURE OF SUPERVISOR'S APPROVAL

DATE

PLEASE SUBMIT COMPLETED APPLICATION TO:

2012 National Veterans Golden Age Games

St. Louis VAMC

1 Jefferson Barracks Dr. 128JB

St. Louis, MO 63125

NVGAG Volunteer Hotline: (314) 894-6160

NVGAG Volunteer Fax: (314) 894-6114

For Volunteer Committee Only:

SIGNATURE OF NVGAG CHAIR OR VOLUNTEERS/DESIGNEE

DATE

VA FORM 0926j, OCT 2011, page 3

Va Form 0926j - Volunteer Application Page 3

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