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VOLUNTEER APPLICATION FORM

Today's Date:
First Name:Middle Name:
Last Name:
Other Names you have been or are currently known by:
Age:yrs
Gender:MaleFemale
Country of Residence:
Email Address:Phone:
Highest Level of Education:High School  &nbspBA/BS   MA/MS/MBA
Ph.D./D.Sc./D.Ed.   MD   JD
Area of Expertise:
(A detailed and verifiable resume must accompany this application from.)
Minimum number of hours per week you can volunteer for IOTM:
Which type of government do you prefer for the future of Iran? Please select one:
Parliamentary Monarchy    Parliamentary Republic
Undecided between Parliamentary Monarchy and Parliamentary Republic
Please list all political, social, human rights or other organizations that you currently belong to whose charter, policies, goals, or activities are related to Iran. If none, write NONE.
Does the charter of any of the above organizations conflict with IOTM’s Mission and 10 Founding Principals as stated in this application form?
Yes     No
If yes, list the organization and the IOTM Founding Principal(s) in conflict:
Have you ever collaborated in any way with the government of the Islamic Republic of Iran or its representatives?
Yes     No
If Yes, explain:


Confidentiality Agreement

Any written, printed, graphic or electronically or magnetically recorded information furnished by IOTM to Volunteer for Volunteer’s use are the sole property of IOTM. Volunteer agrees to promptly return any such materials, and any copies thereof, to IOTM upon the termination of the Volunteer’s services for any reason. Volunteer will keep IOTM’s Confidential data and information in the strictest confidence, and will not use it or disclose it by any means to any person except with IOTM’s prior written approval, and then only to the extent necessary to perform the services directed by IOTM. Volunteer agrees that he/she shall be legally liable for any breach of the obligations in this Confidentiality Agreement.

I hereby confirm and certify that:

a) I am in full agreement with IOTM’s Mission Statement and IOTM’s 10 Founding Principles as described in this application form;
b) All the information I have provided in this IOTM application form are correct to the best of my knowledge;
c) I will avoid using vulgar and mean-spirited language, personal attacks, or any form of disrespectful dialogue or behavior in my communications with IOTM officers and employees, IOTM Volunteers and in general within the framework of IOTM;
d) I will at all times be bound by the IOTM Confidentiality Agreement as stated in this application form;
e) I will notify IOTM within 15 days any changes occur in the personal information provided above;
f) Any task that I perform for IOTM will be purely on a volunteer basis and unless otherwise notified in writing, I do not expect to be compensated by IOTM, and I hereby assign, transfer and otherwise release any and all rights, title and interest that I may acquire in conjunction with IOTM tasks to IOTM;
g) I will abide by all IOTM Policies & Procedures as published by IOTM.

I further understand and agree that:

a) I may resign in writing from IOTM at any time and without any reason(s);
b) IOTM may terminate my volunteer services in writing at any time if it is determined that my actions have been contrary to or in violation of IOTM’s Policies and Procedures;
 
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