Statement of Understanding

I understand that:  The references I listed may be contacted by mail, telephone, or email;  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 youth; the BBBS agency is not obligated to match me with a youth; and, as part of the enrollment processes, I will be asked to provide additional personal information prior to making any recommendations for assignment.  Completion of this application and future interview with the volunteer coordinator do not guarantee acceptance as a Big Brother or Big Sister.  We do not provide reasons for rejecting potential volunteers.  If I am accepted as a Big Brother/Big Sister, I understand my obligation is to meet with my Little Brother/Sister regularly and every month will inform the agency Match Coordinator about the status of my match relationship.  I further agree to accept the supervision of the Match Coordinator and discontinue my volunteer service if the agency requests.  I understand that all materials given to me at any point of time are the sole property of Big Brothers Big Sisters of Greater Rochester or BBBS of America and cannot be reused or reproduced without expressed written consent of BBBS of Greater Rochester.

Big Brothers Big Sisters of Greater Rochester makes determinations of hire or acceptance into the Big Brothers Big Sisters program based on many facets of the applicant’s (potential volunteer, employment candidate, or intern) process (including but not limited to interview, references checks and written application). This policy describes that part of the determination based on information obtained by the applicant’s criminal background screening and Motor Vehicle Record check.

The background screening is only one part of the applicant’s screening process, and the absence of a criminal record does not ensure that an applicant will be accept by the organization. Prior to and/or after the completion of the background screening, Big Brothers Big Sisters of Greater Rochester may choose to deny an applicant’s application. If false information is provided at any time, Big Brothers Big Sisters of Greater Rochester will have the right to terminate the applicant’s application.

The criminal background screening  is a  search of multiple criminal record sources, including but not limited to: federal procurement files, Department of Corrections prison, parole and release files, Administrative Office of Courts records, state criminal record repositories, records from other state and local agencies, Sex Offender Registries, etc.  Big Brothers Big Sisters of Greater Rochester will make a determination based on categories of “criterion offenses” determined by Missing and Exploited Children and other policies.

We must assume all information received is correct. Once the criminal background screening is complete, an applicant may request a copy of their criminal history record. All applicants have the right to challenge the accuracy and completeness of the criminal history record information. In the case of employment or internship, the application may need to be rejected before any challenge to criminal history is complete because of time constraints to fill the position.  Any challenges to the accuracy of the background check findings should be made directly with the identified agency; challenges must be resolved between the applicant and the criminal justice agency. If the applicant has chosen to challenge the accuracy and completeness of the criminal record and reveals new information that may qualify them as an applicant, the applicant may re-apply.

By signing this form, I acknowledge that I have been provided with a copy of this form.  I have read and understood the foregoing and I certify that all statements herein are complete and correct and agree that (a) my references are authorized to furnish information concerning this applicant and are released from all liability for furnishing such information (b) that I may be checked through Commercial Investigations, including a request to the Department of Motor Vehicles, Division of Drivers Licenses, for a list of all violations of the motor vehicle code, (C) a background  check, and (D) that any misrepresentation of omission made by me in this application or any supplement hereto will be sufficient grounds for immediate termination.  I hereby authorize the addressed Police Departments and Court Houses to furnish any criminal or traffic information they may have on record or otherwise, and do hereby release the addressed institution and all individuals connected therewith from all liability for damage whatsoever incurred in furnishing such information.

I further understand that this background check is only one part of the organization’s screening process, and the absence of a criminal record does not ensure that a volunteer, intern or employee will be considered acceptable by the organization.

Big Brothers Big Sisters (BBBS) of Greater Rochester 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, 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 client or volunteer requests otherwise. 

3. For purposes of research, evaluation, audit, or accreditation, and with the prior  written consent of volunteer or client certain outside bodies such as funders, auditors or researchers will have access to information about individuals or match content. Members of the Board of Directors or evaluators appointed by the Board have access to client and volunteer files upon authorization of the Board of Directors. 

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

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

6. State law mandates that suspected child abuse be reported to the Department of Social Services. 

7. 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. 

8. 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, employment status, place of employment, marital status, family status, sexual orientation, living situation, etc.  Information about the child may include such items as: age, sex, race, religion, interests, hobbies, family situation, sexual orientation, etc.  

9. State and Federal law protect the confidentiality of an individual’s HIV status. If HIV status is disclosed to an agency worker, the law prohibits the agency worker from disclosing the information with any other match parties. With that in mind all participants should follow universal precautions to protect themselves from blood borne pathogens.  

10. Information about individuals or match content may be released to Big Brothers Big Sisters of America or other BBBS affiliates at the discretion of the Program Director. 

 11. Throughout the life of the match relationship information relevant to the match or child development will be shared between the match parties. 

Many times our volunteers’ homes have not had child visitors in a while, if ever, and may need some extra care to make them child friendly.  Remember that your Little’s caregiver is entrusting you with her/his child’s safety.  Below are some safety preparations for around your home, property and car and for you to consider when out and about with your Little:

• Notify your Coordinator if you have any weapons during the volunteer enrollment process or if you obtain a weapon at any time during your match.  Steps will need to be taken to ensure that any weapons are locked away and that any ammunition is locked away in a separate location.
• Kitchens are filled with risks and hazards. Put sharp objects and unsafe appliances in your kitchen away in drawers or cabinets. Make sure to put all cleaning supplies or medications away and out of reach.   If you and your Little are going to cook or bake together, be certain to assign your Little age appropriate tasks and to always supervise.
• Because your bathroom is a private space where your Little will be unsupervised, remove sharp objects, cleaning supplies and medications and store in another secure location.
• Alcohol, matches and lighters should be locked up or put out of sight or out of reach.
• Make sure you have a working fire alarm/smoke detector and a fire extinguisher up to date and handy.
• Ensure that you have basic first aid supplies.
• Does your Little know where the phone is in your home and how to use it in case of an emergency?
• Do you have open water, busy roads, or railroad tracks close by?  Does your property have treehouses, ledges, balconies, fire escapes, etc?  If so, be well aware of the potential risks and establish boundaries with your Little about them.
• If you have a pet in your home, make clear to your Little the ways that he/she can safely interact with the pet.  If your pet prefers not to be around strangers or your Little is afraid of animals, be sure to secure the pet in a separate space prior to your Little’s visit.  If your neighbor has pets, remind your Little to always let you take the lead in any interaction with them.
• If you have a pool, review pool safety: fencing, keeping a phone near the pool, drains & covers in place and secure, constant monitoring of your Little in and near the pool with a flotation device handy, regardless of your Little’s swimming ability.
• When you and your Little are together, out in the community or within your home, it is your responsibility to monitor your Little yourself and, with the exception of bathroom visits, have him/her within your sight at all times.  Your little should not be left alone with others, regardless of their relationship to you or your Little’s familiarity with them.
• It is against BBBS policy for you to drive, or otherwise bring along on outings, family members or friends of your Little.  Remember that the purpose of your match is to nurture a one-to-one mentoring relationship and friendship between you and your Little.
• Please review NYS child safety guidelines for automobiles prior to driving your Little.  NYS guidelines include the recommendations that children under the age of 12 sit in the back seat of the car;  children under the age of 8 should also sit in a booster seat.  Both you and your Little should wear seatbelts.
• Be aware of sporting safety, utilizing helmets, pads, etc. as necessary.  Be a good role model for your Little by wearing your helmet and other protective gear as well!

Be sure to contact your BBBS match coordinator with any questions.

With safety in mind you and your Little can have a lot of fun together!

Big Brothers Big Sisters provides reports to our funders to ensure continuation of services. We also collect information and conduct surveys to better serve our matches.

• Information gathered will only be seen by agency staff, contracted researchers and authorized funders.
• Your responses will never be used to determine eligibility
• Participation in Big Brothers Big Sisters includes participating in these surveys and evaluations.

Participation involves the following:

• Acknowledgement that information gathered by agency staff at any time of participation may be used.
• Occasionally you will be asked additional questions during or after the enrollment process about your background and experiences.
• Youth and Volunteers will be asked to participate in a smaller survey conducted every 3 months. The Strength of Relationship Survey (SOR) assists the agency in evaluating the relationship.
• Due to varying funding sources, frequency of surveys and content of information gathered is subject to change. 

For purpose of this policy, weapons may include all firearms, handguns, rifles, air rifles, zip guns, BB guns,  bows, knives (except for kitchen knives and small pocket knives not used or intended for use as a weapon) and explosive devices.

Volunteer Enrollment Procedures as related to Ownership of a Weapon

• During enrollment, the assigned Coordinator will discuss the types of guns/weapons owned, as well as safe and separate storage of firearms and ammunition.
• Assigned Coordinator will conduct a home visit to ensure safekeeping of the weapon.
• If the volunteer is eligible to be matched, a Coordinator will disclose the knowledge of any firearm and/or weapons ownership to the child’s parent/guardian during the offer stages of a pending match and as needed within an active match.
• All discussions regarding gun/weapon ownership will be continually documented and recorded within the match file by the assigned Coordinator.

Big Brothers Big Sisters of Greater Rochester (BBBS) Policy:

All Approved Volunteers agree to:

• Disclose any existing ownership, presence of weapons in the home , or newly acquired firearms and/or weapons at inquiry, enrollment and throughout the life of the match.
• Honestly discuss with BBBS the ownership of the firearms and/or weapons during the volunteer interview and update that status for the life of the match.
• Ensure that weapons and ammunition are inaccessible to the child assigned to you while the child is under your supervision.  The means of inaccessibility will be discussed regularly with your assigned Coordinator.
• To adhere to the policy that a volunteer will not carry a concealed weapon at any time while accompanying the child assigned to you by Big Brothers Big Sisters of Greater Rochester.
• To understand that Big Brothers Big Sisters of Greater Rochester will disclose to the parent/guardian of the child assigned to the ownership or the presence of a weapon in the home. 
• Volunteer and parent/guardian must sign off on the Firearms & Weapons Statement of Attestation  form at the time of the pre match or match.
• To adhere to the policy that a match will at no time engage in activities involving weapons including hunting, target practice etc. without prior BBBS approval including additional approval paperwork.
• As a volunteer, I understand that the safety of the child I am mentoring is my priority and agree to abide by the Weapons Policy of Big Brothers Big Sisters of Greater Rochester