Volunteer Application    

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Non-Discrimination Policy
All BBBS participants, including youth, families, volunteers, board, and staff serving as volunteer Bigs are not excluded on the basis of race, ethnicity, religion, national origin, color, gender, marital status, sexual orientation, gender identity, gender expression, citizenship status, veteran status, or disability. Big Brothers Big Sisters of Acadiana is committed to ensuring its programs are inclusive to all youth and volunteers. Diversity, equity, and inclusion (DEI) are an integral part of our values and mission. We recognize, honor, and celebrate the diverse backgrounds, lives, and experiences of all of our participants, including youth, families, volunteers, and staff.
Basic Information








input NA if none









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Possession of a driver's license is required if you will be transporting a program youth in any vehicle you are operating. 





File can be a screenshot, PDF, or picture



Insurance Declarations — the front page (or pages) of a policy that specifies the named insured, address, policy period, location of premises, policy limits, and other key information that varies from insured to insured. The declarations page is also known as the information page. File can be a screenshot, PDF, or picture.
Contact Information



























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:


Occupational Information











Additional Information




Previous Experience












Volunteer Experience











Reference Checks
Please provide at least three references below including: 
  • Your spouse or domestic partner OR a family member if you do not have a spouse, partner, or significant other.
  • Current or former employee or co-worker you have known for at least one year or someone from your school if you are a student
  • A friend or neighbor you have known for at least two years
























Pre-Interview Questionnaire

Prior to your in-person interview, please answer the questions below. The information you provide will also help us make a better match for you and assure we can support you during your involvement with our program.  Please note that you will have an opportunity to discuss these questions and your responses more thoroughly during your in-person interview.








Release of Information Authorization for Background Check

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

Big Brothers Big Sisters of Acadiana  (“the Company”) may obtain information about you from a third-party consumer reporting agency for employment or volunteer purposes.  Thus, you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends, or associates.  These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records (“driving records”), verification of your education or employment history, or other background checks.  

You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you, and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report.  Please be advised that the nature and scope of the most common form of an investigative consumer report is an employment history or verification.  These searches will be conducted by Asurint, P.O. Box 14730, Cleveland, OH 44114, 800-906-1674, www.asurint.com.  The scope of this disclosure is all-encompassing, however, allowing the Company to obtain from any outside organization all manner of consumer reports throughout the course of your employment or volunteer placement to the extent permitted by law.

This information will be used for background screening purposes only and will not be used as hiring criteriaI acknowledge receipt of the separate document entitled DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents.  I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by Big Brothers Big Sisters of Acadiana (“the Company”) at any time after receipt of this authorization and throughout my employment or volunteer placement, if applicable.  To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Asurint, P.O. Box 14730, Cleveland, OH 44114, 800-906-1674, www.asurint.com.  

 I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.


Confidentiality Policy

In order for Big Brothers Big Sisters of Acadiana to provide a responsible and professional service to clients, it is necessary for volunteers, clients and parents/ guardians to be asked to divulge extensive personal information about themselves and their families. Big Brothers Big Sisters of Acadiana respects the confidentiality of client and volunteer records and, with the exception of the situations listed below, shares information about clients and volunteers only among the agency professional staff. 

 The right to confidentiality applies not only to written records, but also to video, film, pictures and use of client or volunteer names in agency publications. 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 organizations upon presentation of an authorized release of information form appropriately signed by the client or volunteer.
  2. Identifying information regarding clients and volunteers may be used in agency publications or promotional materials unless the client or volunteer request otherwise.
  3. For purposes of program evaluation, audit, or accreditation, and with the prior approval of the Board of Directors, 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 shall have access to client files upon authorization of the Board of Directors.
  5. Information shall only be provided to the agency’s legal counsel in the event of litigation or potential litigation involving the agency.
  6. Information shall only be provided to law enforcement officials or courts pursuant to a valid and enforceable subpoena.
  7. It is required that any agency staff member who has a suspicion that a child is being abused or exploited must report this directly to the Department of Children and Family Services (DCFS) in the parish in which the suspected activity took place. If the misconduct of a current or former Volunteer Big, Board Member, Staff Person, or other adult associated with BBBS (other than the parent/guardian), is involved,  it is reported to Big Brothers Big Sisters of America. 
  8. If an agency staff 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 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 shared about the volunteer may include but not be limited to such items as: age, sex, race, religion, interests, hobbies, marriage, family status, sexual orientation, living situations, any prior felony conviction, etc. Information about the child may include but not be limited to such items as age, sex, race, religion, interests, hobbies, family situation, etc.
Media Release
I, irrevocably consent to any and all uses and displays of my name, image, appearance, basic biographical information, audio/video recording, writings, artwork, and the like, in original form or in modified form, in whole or in part, in , on, or in connection with merchandise, advertising, publicity, marketing, fundraising, and the like, in printed or electronic media, of any type, throughout the world at any time by Big Brothers Big Sisters of America and Big Brothers Big Sisters of Acadiana in their sole discretion, and by any of the affiliates, successors, partners, sponsors, donors, any entities or persons with whom they conduct any public relations, marketing, or fundraising or any type, and any other authorized third parties, without further consent from me, without any royalty, payment, or other compensation to me, and with the release and waiver of any claims, actions, damage, losses, costs, expenses and liability of any kind arising from any such use.
Virtual Platform

I Consent To and Understand That:
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 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 material fact on my application or during my interview process may be justification for refusal of volunteer placement, or if places, will be grounds for dismissal without advance notice

I understand that and consent to the following:

  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.
  8.  I understand that detailed accounts of child abuse or neglect, past or present, will 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 complete questionnaires throughout my time in the program to evaluate and improve program services;
  12. I agree to timely communication and follow-up with all agency staff as required by the agency.

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, accurate, 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 in 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 matters.  I understand that BBBS staff needs to be fully informed to provide the best guidance or support possible.  

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