Big Brothers Big Sisters Volunteer Application (Page 3 of 3) in pdf

I consent to and understand that:

1) The references and youth serving-organization I listed may be contacted by mail, telephone, email, or in-person;

2) The information I provided may be used to conduct a background check, to include a search of public domain records,

driving records check, juvenile and adult criminal history check (see attached authorization), military records, and other

records where required by local, state, or federal law for volunteers working with youth;

3) I am in no way obligated to perform any volunteer services;

4) The BBBS agency 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;

5) Other BBBS agencies and youth organizations where I have worked or volunteered may be contacted as references;

6) As part of the enrollment processes, I will be required to provide additional personal information, including completion of an

in-person interview;

7) 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.

8) I understand that incidents of child abuse or neglect, past or present, must be reported to proper authorities;

9) 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);

10) 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.).

11) 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 Big Brothers

Big Sisters.

I certify that all information I have provided or will provide to Big Brothers Big Sisters, 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 Big Brothers Big Sisters. 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 Big Brothers Big Sisters program, I agree to immediately inform my Big Brothers

Big Sisters contact person of any and all infractions, violations, charges and convictions related to any civil, domestic, or

criminal occurrences. I understand that BBBS staff needs to be fully informed to provide the best guidance or support

possible.

Signature __________________________________________ Date _________

If applicant is under the age of 18, co-signature of a parent/guardian is required for application and to obtain

criminal history record check information:

Parent/Guardian Name:_______________________ Signature:_______________________ Date _____________

Are you interested in learning about additional ways to contribute to the Big Brothers Big Sisters mission?

Yes

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 of which I am a member

Big Brothers Big Sisters Volunteer Application Page 3

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