219 Hubbard Street
Allegan, MI, 49010
Type of work you are seeking (check all that apply) Direct ContactNon-Direct ContactClerical/OfficeOther
Name
Street Address
City
State
Zip
Home Phone
Cell Phone
Email
The best way(s) to reach you is: Home PhoneCell PhoneEmail
Are you at least 18 years of age? YesNo
Have you applied here before? YesNo
If yes, give date
Have you ever been employed/volunteered here before? YesNo
Date available to start
Location preferences or restriction
Volunteer areas of interest (ex. clerical, events, activities, fundraising)
Amount of volunteer time expected/preferred (number of hours per week)
What days and times are you available? Sunday: Monday: Tuesday: Wednesday: Thursday: Friday: Saturday:
Note: Affirmative answers to the following questions will not necessarily bar you from consideration for volunteer opportunities at The Arc of Allegan County.
Have you ever been convicted of ANY crime? YesNo
If yes, please explain
Are there ANY charges pending against you? YesNo
Have charges ever been substantiated against you in an investigation conducted by the Michigan Department of Human Services (Office of Children and Adult Licensing), or by Adult or Child Protective Services? YesNo
If yes, please explain (attach additional pages if necessary)
Have charges ever been substantiated against you for abuse, neglect, exploitation, mishandling client funds or any other recipient rights violations in an investigation by Department of Commerce/Department of Human Services, a local Community Mental Health Recipient Rights Office, or any other recipient rights office? YesNo
Have you ever been administratively determined by a federal, state, or local governmental agency to have committed any of the following?
Assault/Battery: YesNo Abuse or Neglect: YesNo Criminal Sexual Conduct: YesNo
If you answered yes to any of the above, please list the nature of the offense(s), date(s) of conviction and place(s) of offense(s). Criminal convictions may bar volunteer opportunity if in a job related area. Failure to complete this section accurately may be grounds for immediate termination or withdrawal of volunteer offer.
Are you on a court-supervised probation or parole? YesNo
I hereby release The Arc of Allegan County, and the above referenced persons from all claims, liability, and damages that may result from furnishing information to The Arc of Allegan County.
I certify that the information contained in this application is correct. I understand that falsification, misrepresentation, or omission of information on this application may prohibit acceptance to volunteer for The Arc of Allegan County or may be grounds for dismissal. In completing this application and submitting it to The Arc of Allegan County, I understand that any offer is contingent upon meeting necessary requirements for the position, as detailed in the Volunteer Policies & Procedures (pdf).
In consideration for a volunteer position, I agree to conform to the rules and regulations of The Arc of Allegan County, and understand that I may be dismissed from my volunteer position at any time, with or without cause, with or without notice, at the option of either The Arc of Allegan County or myself.
Enter your initials as a representation of your signature:
This form collects your information so we may contact you about your request. Please read our Privacy Policy to find out how we protect and manage your data.
Grant Consent: I grant The Arc of Allegan County consent to collect my contact information.
