Volunteer Application

Home Number *

Social Security Number *

Cell Number *

Can we text this number? *

Yes No

Sex *

Sexual Orientation *

How long have you lived in the area? *

Work Number *

Religion *

Marital Status *

Number of children *

In case of an emergency, whom should we notify? (name, phone number) *

Please list everyone in your home, their age and relationship to you *

Do you have any pets? *

Yes No

Please list *

Please list any arrests, convictions and recent traffic violations. The date that violation occurred and the disposition/result *

Driver's license number and State of issue *

Expiration date *

Have there been any allegation, complaints or reports regarding your involvement in child abuse/neglect, regardless of the outcome? *

Yes No

Do you have guns or ammunition in your home? *

Yes No

How long do you expect to be at your present job? *

Please list any other jobs you have had in the past 5 years. (Employer, City, Job Title, Dates, Reason for Leaving) *

Please list any other addresses you have lived in the past 4 years and the years *

Please list hobbies, interests and or skills: *

Please list 3 references that have known you for at least one year. Please use your spouse or a close family member as one and one work reference (Name, Phone Number or E-mail, Relationship) *

Please list other volunteer positions you have or have had, along with the dates *

Please list any clubs, organizations or groups with which you are affiliated *

Why do you want to be a Big Brother/Big Sister? *

Please list members of Big Brothers Big Sisters with whom you are acquainted: *

Have you applied to become a Big Brother/Sister Before? *

Yes No

Please list any previous experience with you that you have not mentioned thus far *

If yes, where/when? *

Which Program Are You Applying For? *

Are you experiencing any physical or mental health problems? *

Yes No

If yes, please explain *

Are you currently receiving counseling? *

Yes No

I understand that:
1.) The references I listed may be contacted by phone or e-mail
2.) I am in no way obligated to perform any volunteer services
3.) The information I 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 you;
4.) The BBBS agency is not obligated to match me with a youth;
5.) As part of BBBS's enrollment process, we will ask you to provide additional personal information prior to making any recommendations for assignment, and;
6.) Collected information may be shared with the parent/guardian of the child with whom I may be match.

I understand the above statement and herby certify that the information I will disclose during the intake process (i.e. all forms completed and interview) is true, accurate and complete *

I agree