Application

Dear Blanca’s House Team Member,Congratulations and welcome to the Medical Teams Abroad Program with Blanca’s House! Please read the information and follow the instructions below to complete your application for the mission. You are not “officially” a team member until your application is completed, your deposit received and then reviewed by administration to ensure all necessary information is provided.It is mandatory that the following items be provided by every participant:

• • Online Application (below)
  • Medical History Form
  • Acknowledgement Form: Please make sure you have read, understood and signed this form before submitting this document.
  • A color copy of your current passport which indicates your legal name and issuing information. Please make sure you have signed your passport – “Signature of Bearer,” before you scan and electronically attach it via the uploader on the online application. Your signature must match the way your name appears on your passport.

If you are not a US citizen, you may need a VISA to travel. We suggest you call the consulate of our host country for this information or visit their website. Contact our office so we can process a letter and provide your travel itinerary, so the VISA can be issued.

• • Copy of Professional License (medical personnel ONLY) is needed to apply for the work permit in our host country. Please make sure you have signed your license in the licensee/registrant section, before you scan and electronically attach it via the uploader on the online application. Please note: fax copies will not be accepted.

Note: All uploads must be upright, full size and legible.

Team members should contact their team coordinator to determine what supplies and equipment you will need to bring with you. You may want to solicit supplies for the trip from drug companies, instrument manufacturers, etc. We cannot accept expired drugs. We encourage all team participants to fundraise for their trip. As well as helping defray expenses, it raises awareness of our work at Blanca’s House. If you need assistance with fundraising, please click here. HYPERLINK UNAVAILABLE?Please review all policies below before submitting your application. In addition to the costs associated with your trip, you will be responsible for the following items: personal phone calls, safety of your personal belongings, and immunizations. We suggest that you contact your personal physician and/or the CDC’s traveler information website for current immunization information.

• • • $500.00 is due at the time of your application and is non-refundable. This amount is subtracted from the total cost of the mission.
    • Any paperwork and/or payments submitted AFTER the agreed to deadline included your welcome letter, will incur a $250.00 non-refundable surcharge to defray additional administrative costs incurred past the designated deadline.
    • If you cancel your participation in the mission, your $500.00 payment is non-refundable. The above costs have been paid in anticipation of your attendance on the mission.
    • Blanca’s House negotiates group rates with our airline carriers for each mission. All refunds for canceled airline travel are at the discretion of the airline.

We look forward to Crossing Borders to Change Lives with you! Thank you for your time, interest and support. Robyn Feld and Valerie Simpson Blanca’s House Executive Directors

We have no interest in dictating the behavior of our valuable volunteers. However, the adventure of a new and foreign place can sometimes cause us to forget our responsibilities. Each one of you represents Blanca’s House and the U.S or your country of origin, and you should do so with pride. The hard work and reputation of others precedes you, and because of this, you will be held in high respect. Please help us build on that reputation. Remember, you are a guest in the host country. Your hosts will be grateful for your presence and will work diligently to ensure your safety and well-being. Please respect their efforts by not abusing alcohol, behaving inappropriately, or putting yourself or your team in danger. Overindulgence to the point of intoxication, whether from alcohol or drugs, and especially if it interferes with your assigned tasks, will not be tolerated. Team members are expected to interact in a cooperative, team-oriented manner. Do not wander off alone or take unnecessary risks. This will be enforced for both your safety and that of others. While personality conflicts occasionally occur, common sense dictates a team member cannot be persistently combative, hostile, or disruptive towards others; this would defeat our purpose. Keep reasonable hours and plan to arrive at the hospital on time. Remember that nursing and hospital staff, many of them volunteers as well, will be waiting for you. Team members are expected to wake up on time and start each day promptly with their peers. Please dress appropriately. Please do not wear scrubs outside of the hospital. Those who disregard these guidelines will possibly not be asked to return on future missions. We are grateful for the gift of your time on behalf of the world’s neediest and wish you a successful trip. Some of these admonitions may seem unduly harsh to grown adults, but experiences in third-world countries have shown them to be essential. Team members who violate these rules will receive a warning. After a second infraction, the member will be relieved of their team responsibilities and asked to return home at his/her own expense. All Blanca’s House Medical Trips Abroad will include, the following essential medical personnel: team leader, medical director (when indicated), surgeons, director of anesthesia, supervisors, and physicians. If qualified, an individual may serve in more than one capacity. Qualified personnel from within the host country may be available for safety to satisfy these standards, subject to prior approval by the Blanca’s House Team Leader. The Team Leader will review the credentials of all medical personnel providing services in conjunction with Blanca’s House. Approval as a member of a medical team is at the discretion of the Team Leader. THE PROGRAM Blanca’s House is a service-orientated volunteer organization whose main purpose is to deliver healthcare to needy children and their families. Additionally, we deliver thousands of dollars of medical equipment and supplies to our host hospitals. Although we strive to satisfy the expectations of our valued volunteers, it is impossible to satisfy everyone always. It takes just one discontented and disgruntled volunteer to bring an entire program to a grinding halt. Therefore, please be respectful of political and other hot button issues in the host country. Strive to keep neutral in expressing opinions about the country and/or national government. Moreover, most physicians in developing countries, in addition to working part-time for the government, also have private practices. Competition for paying clients can be fierce and this attitude may lead to hostility on the part of some local healthcare professionals toward Blanca’s House. Please be kind, respectful, and open-minded toward all local healthcare workers you encounter. Additionally, please make every effort to make as few demands as possible toward out local hosts. GETTING READY Please make sure you have a current and signed, passport that does not expire for at least six months past the mission RETURN date. If immunizations are needed, begin the process at least six weeks prior to departure. Travel including airfare, lodging, meals, insurance and tips, will be arranged by Blanca’s House at the best group rates. Pack clothing to allow you to dress casually, comfortably, and coolly, but respectfully. Jeans, T-shirts, and shorts are fine. Please avoid midriff-bearing items. Plan to wear whatever shoes you normally use for long cases in the O.R. We try to schedule an end-of-trip celebratory dinner. Therefore, you may want to pack a casual dress, slacks, shirt accordingly. Additional personal items to consider packing are an extra pair of eyeglasses, mosquito repellent, sunscreen, and feminine hygiene products. If you need prescription medications for your personal use, make sure they are in individual containers labeled by your pharmacy. Be aware of Homeland Security limitations regarding carry-on items for air travel. Many volunteers bring along some small goodwill items as tokens of appreciation and “thank you” gifts. Items like pens, key chains, candy, and small toys are wonderful for the children. WHILE THERE We recommend that you take no more than $250 dollars in currency. We suggest 1’s,5’s ,10’s, 20’s. If you feel you need more for purchases, please use a charge card. Please advise your charge company you will be out of the country. Never travel alone. If you enjoy early-morning jogging, do so with a buddy. It is also a good idea to carry a scanned, color copy of your passport with you always. For obvious reasons, do not purchase anything that might be considered contraband by the host government or the U.S.A. Act professionally, and always remember that you are a representative of both your nation, and Blanca’s House. Each volunteer’s flexibility, respectfulness and ability to accept both frustration and success are keys to the program. His/her personal outlook, attitude, preparation, and commitment similarly play an enormous part in the success and effectiveness of the medical mission abroad. Since Blanca’s House is a public charity/non-profit organization, your traveling and lodging expenses are tax deductible. Remember to save your receipts. Your work time and services, however, is not tax deductible. WHEN YOU RETURN

• The hard work and sleepless nights of our mission will take a toll on your immune system. Please keep us informed of any health issues that arise immediately after your return.
• You may feel some sadness. The thrill of our mission and the sudden return to everyday life can leave us all a little empty. You will witness poverty and things that you cannot imagine.

We are grateful for the gift of your time on behalf of the world’s neediest. Our hope is that you return with a different perspective on life. Be PROUD! You will help make a difference in someone’s life…….

PLEASE NOTE, THESE POLICIES WHERE CREATED FOR EMPLOYEES. HOWEVER, WHERE APPLICABLE, THE POLICIES APPLY TO VOLUNTEERS.

ANTI-DISCRIMINATION POLICY – July 2008Blanca’s House is an equal opportunity employer and, as such, considers individuals for employment according to their abilities and performance. Employment decisions are made without regard to race, age, religion, color, sex, national origin, physical or mental disability (including HIV/AIDS), marital or veteran status, sexual orientation, or citizen status, status as victim of domestic violence, arrest or conviction record, and retaliation or any other classification protected by law. All employment requirements mandated by state and federal regulations will be observed.The organization employs affirmative personnel measures to ensure the achievement of equal employment opportunities in all aspects of employment and the work environment. These policies of nondiscrimination will prevail throughout every aspect of the employment relationship, including recruitment, selection, compensation, promotion, transfer, layoff, and recall, termination, and dispute resolution.In keeping with our philosophy and federal and state law, our advertising and recruiting materials will contain the following statement to encourage qualified applicants to apply: “Equal Opportunity Employer.” Our policy as an equal opportunity employer is to employ those legally entitled to work in the United States without regard to citizenship, ethnic background, or place of national origin. However, in conformity with the Immigration Reform and Control Act of 1986 (IRCA), our policy is to hire only those who are eligible to work in the United States. Verification documentation is required of all new hires.All employees in the organization are responsible for following and carrying out this policy according to the spirit and intent of our equal employment commitment. Management provides and supports a dispute resolution procedure for complaints alleging discrimination. Employees are expected to bring any questions, issues, or complaints to management’s attention. If you believe you have been harassed, or if you witness or suspect any violation of this policy, you should report the matter immediately to Robyn Feld, Administrator or Galo Burbano, Secretary. We will not retaliate against you for filing a complaint or cooperating in an investigation, and we will not tolerate or permit retaliation by management or co-workers.AMERICANS WITH DISABILITIES ACTThe Americans with Disabilities Act (ADA) is a comprehensive federal civil rights law that specifically protects individuals with physical and mental disabilities from discrimination in the workplace.Individuals are protected under the ADA if any of the following conditions exist:

• • • They currently have a physical or mental condition that substantially limits their ability to normally conduct a major life function (walking, seeing, hearing, breathing, etc.);
    • They have a history of such impairment; and/or,
    • They are perceived to have such impairment.

The ADA also prohibits discrimination on the basis of an individual’s relationship to someone (parent, sibling, child, spouse/significant other, etc.) with a disability.Blanca’s House offers equal employment opportunities for qualified individuals who may have a physical or mental disability, but are still able to perform essential job functions. Essential functions are defined as the fundamental non-marginal duties of the position being held or sought. A job function is essential if the position exists for the performance of the function, there are only a limited number of employees available to perform it, or it is so highly specialized that an expert is required to perform it.Reasonable accommodation is available to employees and applicants, as long as the accommodation doesn’t cause undue hardship on the organization. Individuals protected by the ADA should discuss their needs for possible accommodation with Robyn Feld, Administrator or Galo Burbano, Secretary.NON-HARASSMENT POLICYBlanca’s House expressly prohibits and will not tolerate any type of harassment at work. Unwanted sexual advances, uninvited sexual remarks or intimidation based on sex are offensive and constitute harassment. Harassment because of age, ancestry, citizenship status, color, disability, gender, marital status, mental condition, national origin, race, religion, sexual orientation or veteran status are prohibited and will not be tolerated. This prohibition covers verbal harassment, disrespectful jokes, innuendos, casual comments of a harassing nature, physical harassment, other inappropriate behavior, inappropriate use of e-mail or the Internet and other offensive, observable pictures or displays. Anyone, including principals, managers, employees, vendors or visitors, who engages in such an action will be subject to disciplinary action up to and including immediate discharge.Any person viewing, displaying, downloading or sending pornographic material from a Blanca’s House computer or by way of a connection to the Blanca’s House computer system at any time before, during or after work hours, on site or remotely, will be subject to disciplinary action up to and potentially including dismissal.Employees should promptly report incidents of harassment to Blanca’s House so that an immediate investigation and corrective action can be taken. The name of the charging party and the person accused of harassment will be kept strictly confident to the extent consistent with adequate investigation and appropriate corrective action. The organization prohibits retaliation against those who claim harassment or participate in an investigation concerning alleged harassment.Examples of Harassment:Whether or not the conduct is intended to be offensive is not relevant; the impact of the comments, jokes or behavior is the key factor. “I was only joking” is not an acceptable excuse.Ethnic, racial or sexual jokes, innuendos, degrading comments, repeated sexual flirtations or propositions are all examples of harassment, whether delivered in person or electronically.The Internet and e-mail systems are intended for business purposes only and must not be used for any form of harassment or for any communications which could be offensive or derogatory. Receiving, viewing, sending or communicating electronically, whether on site or remotely, pornography, offensive or derogatory jokes or comments are examples of harassment. No person is permitted to use the e-mail system to deliver a message that is harassing or offensive on the basis of age, ancestry, citizenship status, color, disability, gender, marital status, mental condition, national origin, race, religion, sexual orientation or veteran status.Recipients of offensive e-mail from outside sources should inform the sender of Blanca’s House’s Non-Harassment Policy and insist the e-mails stop.Incidents of such harassment should be reported promptly to Blanca’s House, so that immediate investigation and corrective action may be taken.HARASSMENT OUTLINEThe subject of harassment in the workplace is a nationwide topic of discussion. Although most of the discussion is about sexual harassment, the topic also includes harassment on the basis of color, race, religion, national origin, disability, age, gender, marital status, citizenship status, sexual orientation, or veteran status.

• • 1. What is harassment? Simply stated: a lack of respect.
    2. It is Blanca’s House policy not to tolerate harassment and any violators of the Firm policy will be subject to disciplinary action, including termination from Blanca’s House. The Firm has established this policy because: 1) it is against the law; 2) claims are expensive and embarrassing for everyone once started, and 3) it is wrong – Blanca’s House’s goal is to create a work environment that is free from harassment of any type.
    3. Blanca’s House prohibits anyone from engaging in the harassment of anyone else on the basis of color, race, religion, national origin, disability, age, gender, marital status, citizenship status, sexual orientation or veteran status.
    4. What is sexual harassment? There are two different types:
       1. Requiring dates or sexual favors as an employment condition. (Quid pro quo)
       2. Employee told that he/she will not be hired, promoted or receive a raise if he/she does not go out with or have sex with their supervisor.

Hostile or offensive working environment.

• • 1. Prohibited sexual harassment includes verbal as well as physical conduct that has the purpose or effect of creating an intimidating or hostile working environment.
    2. The fact that a person does not mean to be offensive is not material – the question is what impact the conduct or words have on the other person. This is very subjective.
    3. The following are some things that could be considered offensive: referring to people as “dear” or “honey.” Hugging or touching. Sexual remarks or jokes. Posting of nude pinups. Having a sexual or lewd screen saver on a PC. Eyeing people up and down.
    4. E-mail and the Internet are for business purposes only and cannot be used for any communication which could be offensive or derogatory, including sexual jokes or comments.

What should employees do? Employee’s Responsibilities to Prevent Harassment

• • • Be aware of your own behavior; make sure your conduct is above reproach.
    • Refrain from the jokes, innuendoes and casual comments.
    • Maintain an environment that fosters respect for individuals.
    • If you hear about harassment from someone else, refer him/her to Blanca’s House.
    • If you know about it, or it has happened to you, report it to Robyn Feld

FORMS OF HARASSMENT

• • • Jokes, innuendoes and casual comments pertaining to sexual, racial, age, national origin, religious, gender, sexual orientation, or disability status.
    • Anything that could be construed as disrespectful.
    • Persistent, unwanted invitations, phone calls, or E-mails.
    • Inappropriate use of E-mail – internal and external visual and observable objects, pictures, PC screens, etc. (icons, cakes, pornography on PC, pictures, “do-dads’ on the desk.)

Remember, if it is offensive to you, your spouse, your mother or your daughter or son, then it is probably HARASSMENT.