High School Bigs Volunteer Application

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12 Characters
1 Uppercase letter
1 Lowercase letter
1 Number
1 Special character

Basic Information

Contact ID 18 Character

Enrollment ID 18 Character

Contact Owner ID

Contact Owner Email

Legal First Name

Preferred First Name

Middle Name

Legal Last Name

Suffix (II, III, Jr., Sr., etc.)

Maiden/Alias

input NA if none

List all other names you use or have used in the past, including married and maiden names, below, separated by a comma:

Birthdate

Social Security Number

Gender

Write In - Gender

Race/Ethnicity

American Indian or Alaska Native	Asian - Chinese
Asian - Filipino	Asian - Indian
Asian - Japanese	Asian - Korean
Asian - Other	Asian - Vietnamese
Black or African American	Hispanic - Cuban
Hispanic - Mexican,Mexican American,Chicano	Hispanic - Other Latinx or Spanish origin
Hispanic - Puerto Rican	Middle Eastern or North African
Other	Pacific Islander - Chamorro
Pacific Islander - Native Hawaiian	Pacific Islander - Other
Pacific Islander - Samoan	Prefer not to say
White or Caucasian

Press CTRL while choosing to select multiple

Tribal & Regional Corporation Affiliations

Nationality

To select multiple, hold CTRL/CMD and click.

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

MM/DD/YYYY

Contact Information

Personal Email

School Email

Preferred Email

Mobile Phone

Home 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

Parent/Guardian Name

Phone

Relationship

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

Additional Information

Please select the region in which you are applying to be a volunteer

Send Email to:

Select County

High School Name

Graduation Year

How would you describe yourself, in terms of participation in events, activities, or sports?

Which activities do you enjoy more?

Do you speak any languages other than English?

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

How did you hear about Big Brothers Big Sisters?

Referral Detail ID

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 Parent/Guardian is required.

Parent/Guardian Reference

Familial Reference ID

Parent/Guardian First Name

Parent/Guardian Last Name

(providing an email address can help speed
up the process for completing references)

Phone

Relationship to you

Years Known

What is your Parent/Guardian's preferred language for communication?

EnglishSpanish

School/Teacher Reference

Teacher First Name

Teacher Last Name

(providing an email address can help speed
up the process for completing references)

Phone

Relationship to you

Years Known

Personal Reference

Friend First Name

Friend Last Name

(providing an email address can help speed
up the process for completing references)

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, nursery/ daycare, nannying, coaching, etc.)

Volunteer Experience

Organization Name

Location

Start Date

End Date

Direct Supervisor First Name

Direct Supervisor Last Name

Phone

Email

(providing an email address can help speed
up the process for completing references)

Years Known

Reason for Leaving

Release of Information Authorization for Background Check

NOTICE

This is to inform you Big Brothers Big Sisters (“BBBS”) may obtain information about you and/or your history related to potential criminal activity. The report from authorized sources may include, among other information, arrest, conviction, and driving record information. BBBS may additionally obtain information concerning your background, character, medical conditions, employment, education, and military experience. Information obtained by BBBS will be used only for the purposes of assessing your suitability to become a volunteer and matching you with a Little Brother or Little Sister.

AUTHORIZATION

I hereby authorize and instruct BBBS to procure a report on me, including a criminal background history, which I understand may include, among other information, arrest, conviction, and driving record information. I also authorize and instruct BBBS to verify my Social Security number and to investigate my background and character in any manner they see fit to evaluate my potential as a Big Brother or Big Sister, including obtaining information from medical providers, employers, educational institutions, military agencies, and any other sources. If I become a volunteer for BBBS, I authorize BBBS to repeat these investigations at any time for as long as I remain a volunteer. I authorize BBBS to disclose relevant information obtained from its investigations to the parent/legal guardian of any child considered as a possible Little Brother or Little Sister to effectively enable the parent to exercise “parental choice” in accepting or denying me as a Big Brother or Big Sister for their child. I authorize and instruct any individual, corporation, and public or private entity having knowledge about me to furnish to BBBS any and all information they may have regarding me. I unconditionally release and hold harmless BBBS and its officers, directors, employees, and agents and any party furnishing information to them pursuant to this authorization from any liability, claims, charges, costs, or causes of action which I or my heirs, executors, or assigns may have as a result of the delivery, disclosure, non-disclosure, or omission of any information. I additionally agree to indemnify BBBS and its officers, directors, employees, and agents for any and all attorney fees, court costs, and other expenses resulting from investigating my background, gathering information concerning me, or verifying personal information about upon the written request of law enforcement agencies. BBBS uses technology tools to enhance personal relationships. Our online platform allows volunteers, youth, parents and BBBS to connect securely using a web application. Furthermore, I understand that BBBS holds the right to deny my participation in the program and, for confidentiality, is not required to disclose reasons for doing so. All parties agree that electronic/digital signatures are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility. A photocopy of this authorization may be accepted in lieu of the original.

Please review the FCRA Summary Of Rights.

I Agree

Background Check Information

Have you lived outside of the UNITED STATES in the past 2 years?

YesNo

Please list all physical locations (city, state, country) you’ve resided in the last 7 years, starting with the current location, then list the beginning and end month/ year you've lived at each.
(if unsure of exact months/ years just list the approximate dates)

City

State

Country

Start Date

End Date

Have you ever had any driving citations and/or moving violations?

YesNo

Details:

Have you ever been arrested, charged, or convicted of a crime, or had a charge or conviction expunged or dismissed?

YesNo

If yes, give details including date, location and nature of the offense and disposition for each such incident (or write "prefer to discuss over the phone/ in person").

3. Have you been or are you currently being investigated for allegedly abusing, neglecting, or exploiting a child, an elderly person, or a person with disabilities?

YesNo

If yes, give details, including the state and county in which each such investigation occurred (or write "prefer to discuss over the phone/ in person").

Confidentiality Policy

Confidentiality Policy

Please read this document in its entirety.

As a potential participant of Big Brothers Big Sisters Lone Star (BBBSLS or BBBS), I understand that I have access to confidential information about volunteers and/or clients and families. I fully understand and accept the responsibilities inherent in my role to maintain the complete confidentiality of all personal information, documents and parties who are engaged in this partnership (collectively, the “Confidential Information”), including myself, BBBSLS and all its affiliates and employees, public figures as well as all children and families that are served by this partnership. The obligation of confidentiality persists indefinitely and is not limited to the period of time beginning with my participation in BBBS and ending at the close of my participation.

In order for BBBSLS to provide responsible and professional services, it is necessary for volunteers, clients and parent/guardians of clients to disclose personal information. BBBSLS respects the confidentiality of client/volunteer information. Confidentiality applies to written records, electronic records, voice, verbal statements, pictures (motion or still) and the use of client/volunteer’s name in agency publications. All records are considered property of the agency, not of agency staff, partner agencies, clients, parent/guardians or volunteers.

I further agree to the following terms:

In the event that an actual breach of confidentiality or a release of Confidential Information has occurred or if a situation which I reasonably believe may result in a breach of confidentiality comes to my attention, I agree to immediately notify the designated BBBSLS representative and/or any other appropriate BBBSLS staff member. I understand and agree that I am required to report such breach or threatened breach of confidentiality regardless of whether the breach is caused by my own actions or by the actions of another person.

According to the Confidentiality Policy, information from client/volunteer records may only be shared with individuals/organizations as specified:

Identifying information regarding client/volunteer may be used in agency publications or promotional material only if the client/volunteer has given written permission.
Information shall be provided to law enforcement or courts only with a valid, enforceable subpoena.
Information shall be provided to BBBSLS legal counsel in the event of litigation or potential litigation involving the agency.
State law requires that suspected or disclosed child abuse, exploitation or neglect be reported to the Texas Department of Protective and Regulatory Services, Child Protective Services.
Information regarding match relationship and match closure reasons shall be provided to other BBBS agencies and youth serving organizations if requested.
If agency staff receives information that indicates that a client/volunteer may be dangerous to himself/herself or to others, steps shall be taken to protect the appropriate party, including a report to the law enforcement authorities.
When a child/volunteer is considered for a match, information is shared between the prospective parties. The identity of the parties is not revealed until after the parties agree to the match. Each party has the right to refuse the proposed match based on the anonymous information provided. Information shared may include: age, sex, race religion, education, interests, hobbies, marriage and family status, living situation, sexual orientation, reasons for applying to the program, expectations for match participation, a summary of the reasons an individual was chosen for the match, and all other information deemed relevant. The individuals to whom the information is provided shall agree not to share the information with any other person.
Certain outside bodies, including members of the Board of Directors, may have access to client/volunteer records for the purposes of program evaluation, audit, accreditation, and/or for purposes of operating and making available approved software, on-line sites and login portals. All such authorized persons and representatives shall enter into a Confidentiality Agreement before receipt of any information from client/volunteer records.
Personally identifiable information of students which is obtained from education records provided by any school district or school will only be used or re-disclosed by BBBS or its authorized representatives in accordance with requirements of the Family Educational Rights and Privacy Act (FERPA). Such information may not be re-disclosed to any third party (except back to the school district or school) without prior written consent of the school district or school, the parent or eligible student. Such information may not be used for any purpose other than the purpose stated in the agreement with the school district or school pursuant to which the information was obtained, and will only be disclosed to those authorized representatives of BBBSLS who have a legitimate interest in the program pursuant to which the information is provided.

Other than in the instances set forth above, information from client/volunteer records shall not be released unless accompanied by an authorized consent to release information form signed by the client/volunteer. If the client is under the age of 18, the consent to release information form must be signed by the student’s parent or guardian.

Thank you for your careful consideration and willingness to uphold the privacy and confidentiality of those participating in Big Brothers Big Sisters.

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

Social Networking Policy

It is the policy of Big Brothers Big Sisters that all agency volunteers who engage in the use of social networking, which includes, but not limited to social media, blogs, wikis, Twitter, Facebook, etc., agree:

To remain a positive role model on all websites that are accessible to the public, recognizing that the child assigned to you by BBBS, and their families may be able to view your information.
To ensure internet postings respect the privacy and confidentiality of the child and families of BBBS by not disclosing any information that is confidential to BBBS, the child assigned to you by BBBS, the child’s parent/guardian, or any BBBS affiliates.
To not share or reveal sensitive information about the child assigned to you by BBBS, including, but not limited to family situation, behavioral problems, medical diagnosis, etc.
To respect the privacy of the family and the child who is assigned to you by consulting with the parent/guardian to gain consent before posting any pictures that include the child or any identifying information of any BBBS child or BBBS family.
To speak respectfully about BBBS and those affiliated with BBBS and refrain from posting information that reflects negatively on BBBS, the child who is assigned to you, or the child’s parent/guardian.
To abide by any other policy or procedure that BBBS may put into effect regarding social media and social networking.
To adhere to all state and federal laws where applicable

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

Program Acknowledgement

Media Release

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.

I consent

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.

Safety Agreement

Weapons/ Firearms

It is the policy of Big Brothers Big Sisters that all agency volunteers agree:

To ensure that weapons, firearms and ammunition are locked and inaccessible to the child assigned to you by BBBSLS and to any other child participating in a BBBS activity while the child is under your supervision.
To adhere to the policy that a volunteer will not carry a weapon openly or concealed at any time while participating in a BBBS activity or while acting in their role as a BBBS volunteer.
All volunteers agree to abide any school guidelines and local, state, or federal laws regarding ownership or possession of firearms, weapons or ammunition. In addition, BBBS volunteers agree to abide by any other policy or procedure that BBBS may put into effect regarding firearms.

Drugs/ Alcohol/ Tobacco

Bigs are not to use, be under the influence, or be in possession of any of these substances while in the presence of their Little. Use of illicit drugs by Bigs (in any setting) is grounds for closure from the program.

All volunteers agree to abide by any school guidelines and local, state, or federal laws regarding the use or possession of the above substances.

I Agree

Program Agreement

I hereby certify that the information provided in this application is true and complete to the best of my knowledge and subject to verification by the agency.

I understand that I am expected to follow all local, state and federal laws.

I authorize the agency its affiliates and their representatives to investigate all information given and to secure additional information, if necessary. I understand that any misrepresentation or omission of a material fact on my application or during my interview process may be justification for refusal of volunteer placement, or if placed, will be grounds for dismissal without advance notice.

I understand that and consent to the following:

1) The references and youth organizations I listed may be contacted by mail, telephone, text or email;

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

3) I will notify my references and any youth serving organization that they should comply with Big Brothers Big Sisters request to complete a reference;

4) The information I provided may be used to conduct a background check now and for as long as I am involved with the agency, to include driving records check, sex offender check, criminal background check, public domain check, and other records where required by local, state, or federal law for volunteers working with youth;

5) In order for Big Brothers Big Sisters Lone Star (BBBSLS) agency to provide responsible and professional services, it is necessary for me, the volunteer, to disclose personal information.

6) All records are considered property of the agency, not of agency staff, clients, parents/guardians, volunteers or authorized persons or representatives; Information from the application interview process, or match support process may be shared between BBBS and partnership agencies when applicable;

7) Big Brothers and Big Sisters Volunteers, as well as the children BBBS serves, their parents/guardians, and BBBS staff and Board Members, are not excluded on the basis of race, religion, national origin, color, gender, marital status, sexual orientation, gender identity, veteran status, or disability;

8) Parents are given the opportunity to express volunteer preferences in a match and those preferences are honored;

9) I must complete a training prior to being matched with a youth;

10) BBBS is not obligated to match me with a youth;

11) If I am accepted as a Big Brother/Big Sister, I understand my obligation to meet with my Little Brother/Sister regularly and to inform BBBS agency staff as to the status of my match relationship every month. I further agree to accept the supervision of the BBBS staff and discontinue my service if I am requested to do so;

12) I understand Big Brothers Big Sisters has a ZERO TOLERANCE FOR ABUSE and takes all allegations of abuse seriously. BBBS will cooperate fully with the authorities to investigate all cases of alleged abuse.

I have read the above statements and accept them as conditions of volunteering. All parties agree that electronic/digital signatures are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility. Checking "I Agree" is my consent to participate in this program and is accepted as my electronic signature.

I Agree

Signature (Please Type Your Name)

By selecting the "I Agree" button, you are signing this agreement/application electronically. You agree that your electronic signature is the legal equivalent of your manual signature.

I Agree

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