BBBS St. Lucie, Indian River, & Okeechobee Counties Volunteer Application

Non-Discrimination Policy

Our participants come to us with a wide range of personal characteristics. We believe that participant eligibility shall be determined without regard to race, color, religion, national origin, gender, marital status, sexual orientation, gender identity, veteran status, or disability.

Basic Information

First Name

Middle Name

Last Name

Maiden/Alias

input NA if none

Preferred Name

Birthdate

Social Security Number

Gender

How do you identify?

Personal Pronouns

What pronouns do you use?

Race/Ethnicity

Relationship Status

Do you have a driver's license?

If you cannot figure out how to upload or are unable that is fine.

Driver's License Number

Driver's License State

Driver's License Expiry

Please upload a copy of your license

File can be a screenshot, PDF, or picture

Auto Insurance Effective Date

Auto Insurance Company

Please upload a copy of your auto insurance.

File can be a screenshot, PDF, or picture

Residence History

Please list all of the different cities you have lived in within the last Five years and ALL states in which you have lived outside of Vero Beach at any time.

City/State

From

To

Contact Information

Personal Email

Work Email

Alternate Email

Preferred Email

Mobile Phone

Work Phone

Work Phone Extension

Home Phone

Alternate Phone

Preferred Phone

Best Time to Call

In general, do you prefer to be contacted by email or phone?

Mailing Address

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

Mailing address is different from residential address

Physical Address

Street Address

City

State

Zip Code

Emergency Contact Information

Name

Phone

Relationship

Are there other adults who live with you?

YesNo

To ensure safety, our process includes a basic screening of other adults living in a volunteer's home. Please list the full name, other names used (maiden, alias, etc.), and birth date of ALL adults 18 year or older living in your home:

Name

Birth Date

Employer Information

Employment Status

Name of Employer

Occupation

Employment Length (Months)

Employment Length (Years)

Employer Address Line 1

Address Line 2

City

State

Postal Code

Is it okay to call at work?

YesNo

Previous Experience

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

When?

Where?

References and Background Check

Please provide at least three references. A reference from a Spouse/Spousal Equivalent or Significant Other is required. Substitute a family member if no Spouse/Spousal Equivalent or Significant Other.

Spousal/Familial Reference

Spousal/Familial Reference ID

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Professional Reference

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Personal Reference

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Have you held a volunteer or paid position where you worked with children in the last five years? (for example counselor at a camp, babysitting, nannying, coaching, etc.)

Volunteer Experience

Organization Name

Location

Start Date

End Date

Direct Supervisor First Name

Direct Supervisor Last Name

Phone

Email

Years Known

Reason for Leaving

I understand that:

The references and youth organizations that I have worked for or been involved with as a volunteer whose information I have provided may be contacted by telephone or email.
I am in no way obligated to perform any volunteer services.
I will be asked to provide my social security number.
I will need to be fingerprinted.
The information I provide may be used to conduct a background check, to include a driving records check, criminal background check, and other records where required by local, state, or federal law for volunteers working with youth. If matched, the information I provided may also be used to conduct an annual criminal background and driving records check. Continued involvement will be based on the information discovered.
Big Brothers Big Sisters has the right to accept or deny program participants and is not obligated to match me with a youth. Big Brothers Big Sisters is not required to provide me with a reason if I am not accepted or matched with a youth.
As part of the enrollment process, I agree to provide additional personal information to assist Big Brothers Big Sisters in making a recommendation for matching.

I accept the terms and conditions

Publicity and promotional materials for Big Brothers Big Sisters are conducted in a variety of forms. By selecting below I authorize Big Brothers Big Sisters to identify me in the media as a Big Brother or Big Sister using my full name. I also give permission for the use of other forms of media including but not limited to written word, photo, video, social media, and voice recording.

PhotoVideoSocial MediaOpt Out

Virtual Platform

Big Brothers Big Sisters of America has developed a digital platform to help Bigs and Littles stay in touch more easily in a safe and secure way. Participation requires your permission.

I consent, should I be matched, to having contact with my Little through Big Brothers Big Sisters' digital platform.

Release of Information Authorization for Background Check

Insert Background Check Terms

I consent to the preparation and release of background reports to Big Brothers Big Sisters of St. Lucie, Indian River & Okeechobee Counties and its designated representatives.

Confidentiality Policy

Insert Confidentiality Policy

I have read and understand the above information provided to me regarding Big Brothers Big Sisters' confidentiality policy. I agree by the conditions set forth.

Social Media Guidelines for Volunteers

Insert Social Media Guidelines

I consent to use images and consent to use my name in promotional materials for Big Brothers Big Sisters of St. Lucie, Indian River & Okeechobee counties.

Firearms and Weapons Guidelines and Attestation

Are there firearms present in your home?

I agree to keep any weapons and ammunition inaccessible to the child assigned to me by BBBS while he/she is in my custody.

Spanish	African Languages (Swahili, Bantu)
American Sign Language	Arabic
Asian: Other	Chinese
Creole	Dutch
Eastern European (Czech, Slovak)	French
German	Greek
Hebrew	Hmong
Indian (Hindi, Punjabi)	Italian
Japanese	Keres (West)
Korean	No Preference
Nordic	Persian
Portuguese	Russian
Turkish	Lao