Name

Address

City

State

Zip Code

Mailing Address (if different)

What is the best way to contact you?---HOME PHONECELL PHONEEMAIL

Home Phone

Cell Phone

Email Address

BACKGROUND CHECK

As you know, the Abayomi Community Development Corporation is a nonprofit organization working to support youth, seniors and families in our community. As part of the application process, we must conduct a criminal background check on all staff and volunteers. By signing this application, you authorize the Abayomi to conduct this check.

Birthdate ( dd / mm / yyyy )

Do you have a valid driver license?YesNo

Have you lived outside the State of Michigan anytime during the last 10 years prior to today's date?YesNo

Have you ever been convicted of any criminal offense?YesNo

Have you ever been charged with a criminal offense involving children?YesNo

Have you been arrested, convicted, plead no contest or plead guilty to a felony or misdemeanor? YesNo

PLEASE CHECK YOUR AREA OF INTERESTS

Tell us which assignments you are interested in volunteering (check all that apply)Data EntryEventsFollow Up Calls to ClientsWorkplace GivingMarketing PacketsPhone-a-ThonNewsletter ProductionProgram Packets

Tell us which programs you are interested in volunteering (check all that apply)Youth DevelopmentFamily Supportive ServicesHousing & Economic DevelopmentCenter for Financial Advancement

JR. NBA COACHING

Have you ever coached before? YesNo

Briefly describe your coaching experience.

Which age group would you like to coach?5-67-89-1112-14

AUTHORIZATION

I understand that my enrollment as a volunteer is contingent upon successful completion of the application process. I give my permission for the above-named references to release information about me and for my criminal history to be verified. I understand that the Abayomi CDC will handle this application in a confidential manner. I agree to serve as a volunteer for the Abayomi CDC. I understand that either party may cancel this relationship at any time.

I certify that the above information is correct. I agree to inform Abayomi CDC of any changes.Yes