Volunteer Application

Your Name *

First

Middle

Last

Email *

Email

Confirm Email

Date of Birth *

Gender *

Ethnicity *

Marital Status *

Home Phone *

Cell Phone *

Address *

City *

State

Zip Code *

Work Phone *

May we contact you at work? *

Occupation *

Employer *

Employer's Street Address *

City *

State

Zip Code *

Work Hours *

How long have you been employed there? *

Highest Level of Education *

Do you have a driver's license? *

License #

State of Issue

Expiration Date

REFERENCE #1 - Name of a current/past employer who has known you for at least one (1) year: *

(or school if a student)

Supervisor's Name *

(or teacher if a student)

Address *

City *

State *

Zip Code *

Day Phone *

Fax

Email

Confirm Email

REFERENCE #2 - Name of a co-worker, friend or neighbor who has known you for at least two (2) years:

Address *

City *

State *

Zip Code *

Day Phone *

Fax

Email

Confirm Email

PREVIOUS VOLUNTEER EXPERIENCE: Have you ever applied to be (or have been) a Big Brother or Big Sister? *

If yes, where and when?

What, if any, other youth organizations have you worked for or been involved with as a volunteer?

Have you ever been involved with BBBS in a capacity other than a Big? *

If yes, where and when?

QUESTIONNAIRE: Parents of youth in our programs often ask us questions about someone with whom their child will be matched. This information will also help us make a better match for you and ensure that we can support you during your involvement with our programs. We will only release information to a parent with your expressed permission. *

I understand that this information will only be released to a parent with my express permission.

Which do you enjoy more? *

Would you describe yourself as a person who enjoys: *

Do you have guns or ammunition in your house? (Safety precautions may be necessary) *

Would you be able to secure or otherwise make unavailable any youth inappropriate viewing materials in your home? (These include TV channels, internet access, etc.)

If not, please explain:

Do you have any pets? (Safety precautions may be necessary) *

If yes, what kind of pet(s)?

Are you having any physical or mental health problems? *

If yes, please explain:

Have you ever been arrested, charged, or convicted of a crime? *

If yes, please explain:

Have you had any driving citations or moving violations in the past 5 years? *

If yes, please explain:

How long have you lived in the area? *

Do you anticipate any significant life changes over the next year or have you had any in the past year? *

If yes, please explain:

Do you speak any foreign languages? *

If yes, please list:

Is there anything else you would like to tell us about yourself or do you have any questions?

ACKNOWLEDGEMENT: By submitting this form, you understand that: The references listed above may be contacted by mail, phone, or e-mail; You are in no way obligated to perform any volunteer services; The information provided may be used to conduct a background check, to include driving records check, criminal background check, and other records where required by local, state, or federal law for volunteers working with youth; The BBBS agency is not obligated to match you with a youth; Other BBBS agencies or youth organizations where you have worked or volunteered may be contacted as references; As part of the enrollment process, you will be asked to provide additional personal information prior to any recommendations for assignment. *

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