Volunteer Application

Program for which you're applying: *

GENERAL INFORMATION

Name: *

First

Middle

Last

Preferred Name:

Cellphone #:

Home Phone #:

Work Phone #:

Is it okay to text you?

Home Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Personal Email: *

Work Email:

How do you prefer to be contacted? (phone, email, time of day, etc.) *

Social Security Number: *

Date of Birth: *

Gender: *

Marital Status: *

Race/Ethnicity (Click all that apply): *

Nationality/Country of Origin: *

Occupation: *

If not applicable, please indicate N/A.

Employer: *

If not applicable, please indicate N/A.

Length of Employment & Work Hours: *

If not applicable, please indicate N/A.

Highest Level of Education: *

Area of Study:

Are you a student at this time? *

If a student, please name school:

Do you have current or past military experience? *

Dates of Service:

Branch:

Component:

Are you retired from the military?

If retired, separated, or discharged, please select the character of separation/discharge below and email a copy of your Form DD 214 to t.kline@bbbswcmd.org or fax it to 301.739.8914.

Possession of a driver’s license is required if you will be transporting a program youth in any vehicle you are operating.

Do you have a current and valid drivers license? *

If yes, state of issue and #:

Expiration Date:

Do you own a vehicle? *

Do you have valid insurance that meets or exceeds state required minimum? *

Have you previously applied to be or served as a Big Brother/Sister here or anywhere else? *

If yes, when and where?

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

If yes, when and where?

Have you ever been involved with or volunteered for another youth organization(s)? *

If yes, when and where?

Have you ever been denied acceptance or release from services as a volunteer or employee for another Big Brothers Big Sisters program or youth-serving organization? *

If yes, when and where?

Are you interested in learning about additional ways to contribute to the Big Brother Big Sisters' mission? *

If yes, please check all interests that apply.

Becoming a donor
Helping to recruit volunteers
Volunteering at agency events for matches, Littles, waiting-list children, etc.
Volunteering at agency fundraising events
Inviting BBBS to speak at a company, church, organization, or other group

REFERENCE INFORMATION

Please list information for at least three references below including: 1. Your Spouce or domestic partner (i.e., if you live with a signficant other/girlfriend/boyfriend) 2. Current or former employer or coworker you have known for at least one year, or someone from your school if you are a student; AND 3. A friend or neighbor you have known for at least two years.

Spouse/Partner or Family Member (if no spouse/partner): *

First

Last

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

If international address, enter it here.

Day Phone #: *

Cellphone #:

Email: *

Please enter "Unknown" if you're unable to retrieve this information.

Employer or Coworker (current or most recent) or school personnel (if you are a student): *

First

Last

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

If international address, enter it here.

Day Phone # *

Cellphone #:

Email: *

Please enter "Unknown" if you're unable to retrieve this information.

Friend, Neighbor, or Other Personal Reference: *

First

Last

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

If international address, enter it here.

Day Phone #: *

Cellphone #:

Email: *

Please enter "Unknown" if you're unable to retrieve this information.

In addition to the references above, Big Brothers Big Sisters of Washington County requires references from all youth-serving organizations at which you have worked or volunteered within the last five years. Please list additional on a separate page, if needed.

Organization: *

If not applicable, please indicate N/A.

Direct Supervisor:

First

Last

Address:

Address Line 1

Address Line 2

City

State

Zip Code

If international address, enter it here.

Day Phone #:

Cellphone #:

Email:

Please enter "Unknown" if you're unable to retrieve this information.

Dates of Involvement/Employment:

Reason for Leaving:

Organization:

Direct Supervisor:

First

Last

Address:

Address Line 1

Address Line 2

City

State

Zip Code

If international address, enter it here.

Day Phone #:

Cellphone #:

Email:

Please enter "Unknown" if you're unable to retrieve this information.

Dates of Involvement/Employment:

Reason for Leaving:

Organization:

Direct Supervisor:

First

Last

Address:

Address Line 1

Address Line 2

City

State

Zip Code

If international address, enter it here.

Day Phone #:

Cellphone #:

Email:

Please enter "Unknown" if you're unable to retrieve this information.

Dates of Involvement/Employment:

Reason for Leaving:

I consent to and understand that:

The references and youth serving organization(s) I listed may be contacted by mail, telephone, email, or in-person.
The information I provided will be used to conduct a layered, multi-jurisdictional (local, state, & federal) criminal background and driving record check, to include a search of public domain records, juvenile and adult criminal history records, military records, and other records where required by local, state, or federal law for volunteers working with youth (see attached authorization)
I am in no way obligated to perform any volunteer services.
Big Brothers Big Sisters of Washington County (BBBS) is not obligated to match me with a youth and may deny my application or close my match at any time, and to protect all participants’ confidentiality, BBBS is not required to disclose reasons for doing so.
Other Big Brothers Big Sisters agencies and youth organizations where I have worked or volunteered may be contacted as references.
As part of the enrollment processes, I will be required to provide additional personal information, including completion of an in-person interview.
I understand that the information I provide in the enrollment process will be kept confidential unless disclosure is required by law and with exceptions noted below.
I understand that incidents of child abuse or neglect, past or present, must be reported to proper authorities.
I understand that certain relevant information about me will be discussed with the parent/guardian of a child who is a prospective match (this might include demographic information, information relevant to parent/child preferences, and any information relevant to a child’s safety or well-being).
It is my responsibility to update the agency if any of the information I provide on this application, in my interview, or any other information provided during the enrollment process changes (i.e. address, phone number, auto insurance, new criminal charges, etc.).
I agree to timely communication and follow-up with all agency staff.

Please read the following carefully before signing this application: I understand that this is an application for a volunteer opportunity and is not a promise or commitment by BBBS. I certify that all information I have provided or will provide to BBBS, including this application, is true, correct and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would affect my application for a volunteer position. I understand that information contained on my application will be verified by BBBS. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant or my termination as a volunteer. At any time while involved with the BBBS program, I agree to immediately inform my BBBS contact person of any and all infractions, violations, charges and convictions related to any civil, domestic, or criminal occurrences. I understand that BBBS staff must be fully informed to provide the best guidance or support possible.

Type your name here if you wish to accept the terms of this agreement. Your typed name will be as binding as your signature. *

Date:

VOLUNTEER PRE-INTERVIEW QUESTIONNAIRE

Prior to your in-person interview, please answer the questions below. Parents of youth in our programs will often ask questions about someone with whom their child will be matched. The information you provide will also help us make a better match for you and assure we can support you during your involvement with our program. Please note that you will have an opportunity to discuss these questions and your responses more thoroughly during your in-person interview.

Name: *

First

Last

1. Do you have any concerns about your ability to fulfill the 12-month commitment required of mentors? *

2. Do you anticipate any significant life changes over the next year or had any this past year? *

If yes, please describe:

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

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

If yes, do you have more than six points on your license?

5. Do you have guns, ammunition, or other weapons in your house? *

6. Are you experiencing any physical or mental health issues? *

If yes, please describe:

8. Do you speak any foreign languages? *

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

10. Are there other people living in your household? *

If yes, provide name, age, relationship to you.

Name, Date of Birth, Relationship:

I have answered these questions honestly and completely to the best of my knowledge.

Type your name here if you agree with the statement above. Your typed name will be as binding as your signature.

Date: *