ABVI Volunteer Application Form

We encourage you to fill this form out online and send it to us using the "Submit Application" button at the bottom of the page.

If you prefer to print it first, please return this completed application by mailing it to:
Association for the Blind & Visually Impaired
Attention: Joy Wahby
456 Cherry SE
Grand Rapids, MI 49503

For more information, please call Joy Wahby at 616-458-1187 or 1-800-466-8084 or email at abviadmn@abvimichigan.org.

Date of Application:
   
Name:
Street Address:
City, State, Zip:
County:
Birth Month:
Birth Day:
Birth Year:
Daytime Phone:
Evening Phone:
Email Address:
   
Emergency Contact:
Emergency Phone:
   
If you are under 18 years old, do you have a work permit? (yes/no) Yes    No
Have you ever been convicted of a crime? (yes/no) Yes    No
   
 
Educational Background (please provide school and grade completed):  

High School:

College:

Other:

 
 
Do you speak any languages other than English (please list):
What is the most important thing we should know about you:
Have you had any previous experience working with the visually impaired (please describe):
Please describe any previous volunteer experience:
When are you able to volunteer? (Weekdays, Weekends, Daytime, Evening):
 
What type(s) of volunteer work are you interested in? (Check all that apply):
AGENCY SERVICES
Receptionist
File Assistant / Clerical
Braille Dept.
Community Education / Speaker

CLIENT SERVICES
Reader
Driver
Shopper / Aide

SPECIAL EVENTS
Committee Member
Event Worker
Mailings (stuff envelopes)
 
 

REFERENCES - Please give us the information on your current or most recent employer:
Name of Company:
Supervisor:
Address and Zip:
Phone:
Tell us about your work.
 

REFERENCES - Please give us the information on a personal reference (other than family):
Name:
Address and Zip:
Phone:
 

By signing this application, I certify that the statements made by me are true and complete to the best of my knowledge. I understand that false statements herein are sufficient grounds for rejection of this application and/or dismissal. I also acknowledge the agency's policies on confidentiality and will treat all information about clients with strict confidence. I understand that client information must be protected from the possible consequences of being inappropriately released. Violation of client trust is cause for immediate dismissal Inquiries from the news media should be referred to the immediate supervisor or any ABVI staff member.

I accept    I do not accept

 
 

CRIMINAL HISTORY, BACKGROUND CHECK AUTHORIZATION WAIVER OF LIABILITY

In an effort to provide for the safety of our clients, the Association for the Blind and Visually Impaired (ABVI) reserves the right to conduct background and reference checks on all volunteers who will work with or near our clients.

As a prospective volunteer of ABVI, I authorize ABVI to request from the criminal records division of the Department of State Police and the Grand Rapids Police Department a criminal history check prior to an offer/placement using the information below:

Legal Name Last:
First:
Middle:

 

Maiden Name (or name previously used) Last:
First:
Middle:

 
Birth Date:
Race:
Sex: Male    Female
Social Security#
Driver's License#
 

I understand that the above information is required by central records division of the Michigan State Police Department and the Grand Rapids Police Department. I hereby release and forever discharge ABVI, the State of Michigan, the City of Grand Rapids, and their respective agents and employees from any and all actions, causes, claims and demands for, upon, or by reason of any damage, loss or injury which may be sustained by me in nature of libel, slander, invasion of privacy or other resulting from errors or omissions in the information given or from the use of information, whether by reason of unauthorized use, negligence, or otherwise.

I authorize my current and/or former employer(s) to provide ABVI any information regarding my employment together with any information they may have regarding me, whether or not such information is in their records. I hereby release my current/former employer(s) and their agents and employees from all damages whatsoever for issuing such information to ABVI.

I accept    I do not accept