The following statements have been organized in a manner to which client rights and
responsibilities are explained in general terms and in other terms regarding specific services. By
signing this agreement, I am testifying to AFPS Client Services that my opinions do not differ
and that I have clarified any details that were unclear to me. This document may be referred to
throughout services.
Client Rights Before or After Job Placement
1. To review my case records at any time by notifying the DSP with whom I
am working.
2. To know about AFPS Client Services as an organization including:
• The types of services offered
• The eligibility criteria
• Any policies and procedures that affect the services I may receive
• The approximate waitlist for services
• Previous performance outcomes
3. To participate in establishing all plans and goals for the services I am receiving, including
expressing any opinions or desires I have about all services I wish to receive.
4. To invite anyone, I wish to all meetings held regarding the services I am receiving.
5. To refuse services. I can then expect appropriate staff to explain to me the consequences
of that decision.
6. To request to work with a certain DSP and to have that request reviewed by the Director.
7. To complete confidentiality. I understand that staff from AFPS Client Services cannot
release any confidential information to any outside sources without written permission from
me or my legal guardian.
8. To appeal a decision that is made that I do not agree with by contacting the Director and/or
my DVR Counselor. I agree to talk about the disagreement initially with my DSP, but if an
agreement cannot be reached, I also have the right to contact DVR Counselor or DDDS Case
Manager regarding unhappiness with services.
Client Responsibilities Before or After Placement
1. To keep my DSP informed of any upcoming events that would require long-term absence
from my job or job development activities, such as vacations or
surgeries.
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2. To disclose any criminal record or conviction of a crime other than minor traffic violations to
AFPS. I understand that not disclosing this information to an employer and the with whom
I'm working may disqualify me for employment and/or further Client Services.
3. To make known any potential risks to my health and/or safety that may impact my ability to
receive services from AFPS Client Services. Risks are considered to be exposure to a
predictable event or environment that could result in serious physical or psychological injury
to me or someone else.
4. To be truthful with my DSP in order to receive the best possible services during job
development and after job placement.
5. To communicate with my DSP continuously throughout services. I am depended upon to
keep my DSP updated on any happenings during job development and after placement. For
example, if an employer calls me for an interview or if I am being mistreated at work, I will
notify the DSP immediately. I also agree to speak with my DSP before acting on decisions
that I have made to determine consequences of that decision and the best possible outcome.
Client Rights and Responsibilities Specific to Job Development
1. I agree to actively participate in my job search. I will assist the DSP in establishing goals
towards successful employment and follow my DSP’s guidance in locating a job that suits
my employment desires and needs. I also will keep my DSP fully informed of where and
when I have job searched on my own in
the community.
2. I will notify my DSP of any occurrence related to finding a job including, but not limited to,
calls from potential employers, upcoming interviews, or changing employment desires.
3. I have the right to accept or not accept any employment that is offered to me and can expect
my DSP to discuss the outcome of that decision with me.
General Understandings (After Placement)
1. I understand there might be several AFPS staff working with me until I am able to do my job
independently. Therefore, I agree to accept instructions from any Job Coach during job
coaching.
2. I understand that once the DSP, my employer, and I agree that AFPS Client Services support
can fade, a Job Coach will be available to spot check and monitor my work.
3. I understand that my employer and AFPS staff may regularly review my work performance.
4. It is the responsibility of the employer to follow all labor laws, including minimum wage,
personnel records, family leave, etc.
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By signing below, I acknowledged that I have reviewed and understand my rights and
responsibilities as a person receiving services from AFPS.