- 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.
- 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
- 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.
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.
- What is harassment? Simply stated: a lack of respect.
- 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.
- 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.
- What is sexual harassment? There are two different types:
- Requiring dates or sexual favors as an employment condition. (Quid pro quo)
- 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.
- Prohibited sexual harassment includes verbal as well as physical conduct that has the purpose or effect of creating an intimidating or hostile working environment.
- 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.
- 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.
- 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.
- 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
- 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.)
I grant to Blanca’s House and its representatives the right to take photographs of me in connection with Blanca’s House missions. I authorize Blanca’s House, its assigns and transferees to copyright, use and publish the same in print and/or electronically.
I agree Blanca’s House may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.