BBBS East TN Volunteer Application

Basic Information

Contact ID 18 Character

Enrollment ID 18 Character

Contact Owner ID

Contact Owner Email

First Name

Middle Name

Last Name

Maiden/Alias

input NA if none

Preferred Name

Birthdate

Gender

How do you identify?

Personal Pronouns

What pronouns do you use?

Sexual Orientation

Please specify

Race/Ethnicity (press CTRL to select multiple)

Tribal & Regional Corporation Affiliations

Nationality

To select multiple, hold CTRL/CMD and click.

Relationship Status

Do you have a driver's license?

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 seven years and ALL states in which you have lived outside of Alaska 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

County

Knoxville Office:

Anderson, Blount, Knox, Sevier

Tri-Cities Office:

Carter, Hawkins, Roane, Sullivan, Washington

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 who you have known at least a year and have ideally observed you around children. A reference from a Spouse/Spousal Equivalent or Significant Other is required. Substitute a Parent or Adult Child if no Spouse/Spousal Equivalent or Significant Other.

Spousal/Familial Reference

First Name

Last Name

Email

Phone

Spousal/Familial Reference ID

Relationship to you

Years Known

Professional Reference (Direct Supervisor)

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 (leave blank if present)

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

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.I DO NOT consent, should my child be matched, to having my child contact their Big through the BBBS digital platform.

Confidentiality Policy

Big Brothers Big Sisters of East Tennessee respects the confidentiality of client and volunteer records and, with the exception of situations listed below, shares information about clients and volunteers only among the agency professional staff.

All records are considered the property of the agency and not the agency workers or clients or volunteers themselves. Records are not available for review by the clients or volunteers.

1. Information will be released to other individuals or non-BBBS organizations only with the client or volunteer's written consent.

2. Identifying information regarding clients and volunteers may be used in agency publications or promotional materials unless the clients or volunteer request otherwise.

3. For purposes of program evaluation, audit, or accreditation, and with the prior approval of the Board of Directors, certain outside bodies such as Big Brothers Big Sisters of America may have access to client and volunteer records.

4. Members of the Board of Directors or evaluators appointed by the Board have access to client files upon authorization of the Board of Directors.

5. Information shall only be provided to law enforcement officials or the courts pursuant to a valid and enforceable subpoena.

6. Information shall be provided to an agency's legal counsel in the event litigation or potential litigation involving the agency.

7. State law mandates that suspected child abuse be reported to the Tennessee Department of Children's Services.

8. If an agency worker receives information indicating that a client or volunteer may be dangerous to himself or herself or to others, necessary steps may be taken to protect the appropriate party. This may include a medical referral or report to the local law enforcement authorities.

9. At the time a child or volunteer is considered as a match candidate, information is shared between the prospective match parties. The information about the volunteer may include such items as: age, sex, race, religion, interests, hobbies, marriage, family status, sexual orientation, living situation, etc. Information about the child may include such items as age, sex, race, religion, interests, hobbies, family situation, etc.

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.

Firearms and Weapons Guidelines and Attestation

A. If a Big owns any type of firearm the Big is required to disclose that information to BBBS staff. BBBS will make the guardian aware of the firearm.
B. The firearm should be secured from the Little at all times, unloaded, with the ammunition also secured and located in a different part of the residence.
C. Even if the Big has a carrying permit, they are not permitted to carry a concealed weapon with them on outings. Exception ONLY for police officers.
D. If the child has access to firearms at the home, the Big would be allowed to attend gun safety training courses with the Little once approved by the CEO.

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, unless on a specifically approved match activity, as described above.

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