Mid Michigan BBBS Logo                                                                                   Volunteer Application

Non-Discrimination Policy
All applications will be given equal consideration regardless of race, age, sex, disability, marital status, sexual orientation, gender identity, religion or national origin. All content is property of Mid Michigan Big Brothers Big Sisters.
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Program Interest









Basic Information





input NA if none














































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Our Auto Insurance Liability requirements are:
  • $100,000 Combined Single Limit or $100,000/$300,000 Bodily Injury,
  • $100,000 or higher property damage, AND
  • $100,000/$300,000 for Uninsured/Underinsured Motorists






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Employer Information











Additional Information



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References and Background Check

Previous Experience










Volunteer Experience












  • Your spouse or domestic partner (i.e., if you live with a significant other/partner) OR a family member if you do not have a spouse, partner, or significant other;
  • Current or former employer or co-worker you have known for at least one year or someone from your school if you are a student; AND
  • A friend or neighbor you have known for at least two years
Spousal/Familial Reference











Professional Reference











Minimum 1 year
Personal Reference












Minimum 2 years
I consent to and understand that:
  1. The references and youth-serving organization(s) 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 and with exceptions noted below.
  8. I understand that incidents of child abuse or neglect, past or present, must 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.

Pre-Interview Questionnaire

Prior to your in-person interview, please answer the questions below. The information you provide will 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.  













  
Other Adults in the Home
Please provide the name, age, and relationship to you for anyone else residing in your home.






Firearms & Weapons Policy

  1. All Volunteers must disclose any firearms and/or weapons ownership to BBBS agency staff on Volunteer application and throughout enrollment and the life of the match.
  2. Agency Staff will notify and document Parent/Guardian notification of Volunteer firearm/weapons and ground rules for such.  This includes possession of Concealed Carried Weapon Permit and Concealed Pistol License.
  3. All firearms, weapons, and ammunition must remain locked and inaccessible to Child, unless Volunteer has gained specific event permission from Parent/Guardian to attend approved event such as hunter safety, shooting lessons, or youth hunt.
  4. Volunteer will never leave unattended firearm/weapon with Child while Child is unattended.
  5. For police officers or others required to wear a gun for employment, written approval is required from Executive Director and signed ground rules with exception noted.
  6. If Volunteer or household member has a Concealed Carried Weapon permit or Concealed Pistol License, they must agree to keep said weapon inaccessible to the Child at all times and follow proper child safety procedures to keep all parties safe while weapon is present and unlocked.  Parent/Guardian must be made aware and sign acknowledgement form.




Marijuana Policy

  1. All Volunteers must disclose any marijuana use or presence in the household to BBBS Agency Staff on Volunteer application and throughout enrollment and the life of the match.
  2. Agency Staff will notify and document Parent/Guardian notification of Volunteer marijuana use/possession and ground rules for such.  
  3. All substances and paraphernalia must remain locked and inaccessible to the Child while in the custody of the Volunteer.
  4. Volunteer will not use marijuana a minimum of 12 hours prior to or while spending time with the Child.

Release of Information Authorization for Background Check

I acknowledge and agree that: 1) I am not obligated, if called upon, to perform the volunteer services herein applied for and the agency is not obligated to assign me a Little; and  2) as a part of the agency's selection process, police records, employment history and automobile insurance will be checked by professional agency personnel. I certify that all of the information given in this application is true and accurate to the best of my knowledge and further authorize Mid Michigan Big Brothers Big Sisters and its satellite programs to use proper channels to verify the same.

 

I authorize Mid Michigan Big Brothers Big Sisters to submit information from this application to Datasource, DHHS, Michigan State Police and County Police, and online and national background check services for a full criminal background check.  I agree that if I become a volunteer that periodic background checks can be conducted during the term of my volunteerism


I hereby authorize the Michigan State Police and/or Datasource to release any information it may have in its records or may obtain from other sources under my name/drivers license/birth date, to Mid Michigan Big Brothers Big Sisters. Further, I hereby release and forever discharge the State of Michigan, the Michigan State Police, County Police, Child Protective Services, and Datasource from any and all actions, causes of actions, claims, and demands for, upon or by reason of any damage, loss, or injury or other resulting from errors or omissions in the information given or from the use of the information, whether by reason of unauthorized use, negligence, or otherwise.

 

I understand that all of the information I have provided to Mid Michigan Big Brothers Big Sisters and all programs may be substantiated by my employment, character references, records of law enforcement agencies, or courts of law and give my permission to do so.  


I understand that I do not have to sign a release form.  I do not have to allow Mid Michigan Big Brothers Big Sisters to access confidential information and that signing this section of the form is voluntary.  I understand that this is valid when I sign it and that I may withdraw my consent to this release at any time written or orally. For purposes of this Authorization and Release, an electronic signature or photocopy of my signature shall have the same force and effect as my original signature.  

I understand that Mid Michigan Big Brothers Big Sisters has an obligation to keep my personal information and records confidential using only for the purposes of being a participant in the MMBBBS program.

I understand Big Brothers Big Sisters requires all adult members of the household in which I reside to complete a criminal background check. I further understand that any member of my household may refuse to have a criminal background check done. The refusal will be noted in the case notes, brought to the attention of the parent at the time of the match and possible could result in my being declined as a Big. I understand the responsibility for the child I am matched with is ultimately mine. Big Brothers Big Sisters discourages anyone other than the volunteer from transporting the child.

Consent and Release Policy

I irrevocably consent to any and all uses and displays of my name, image, likeness, appearance, basic biographical information, audio/video recordings, 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 American and Mid Michigan Big Brothers Big Sisters in their sole discretion, and by any of their affiliates, successors, partners, sponsors, donors, any entities or persons with whom they conduct any public relations, marketing, or fund raising of any type, and any other authorized third parties, without further consent from me, without any royalty, payment, or compensation to me, and with the release and waiver of any claims, actions, damages, losses, costs, expenses and liability of any kind arising from any such use (the "Released material").


In consideration of the mutual promises made herein, and for other good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge, I hereby grant to BBBSA and its affiliates the right to use the Released Material as BBBSA and/or its affiliates may desire, in all media now existing or hereafter created and in all variations and forms including, but not limited to, internal or external publications or productions, informational or recruitment materials, marketing materials, fundraising materials, televised photography and/or recordings, advertisements, Public Service Announcements, and/or online and social media sites.  The use of this information shall be at the sole discretion of BBBSA and/or its affiliates.  

 

I further grant to BBBSA and its affiliates the absolute right to use the Released Material in whole or in part, alone or in conjunction with any other image, name, writings or reproduction, in color or otherwise, for art, advertising, business, trade, or any other lawful purpose whatsoever, in perpetuity throughout the world.

 

I understand and agree that all materials created by BBBSA and/or its affiliates that use the Released Materials are the property of and are owned by BBBSA, and that I cannot authorize their use by any other party.  I further understand that BBBSA may authorize their use by a third party.  I hereby irrevocably transfer and assign to BBBSA my entire right, title and interest, if any, in and to the Released Materials and all copyrights in the Released Materials arising in any jurisdiction throughout the world, including the right to register and sue to enforce such copyrights against infringers.  

 

I acknowledge and agree that I have no right to review or approve the Released Materials before they are used by BBBSA and/or its affiliates, and that BBBSA has no liability to me for any editing or alteration of the Released Materials or for any distortion or other effects resulting from BBBSA’s and/or its affiliates’ editing, alteration or use of the Released Materials.  BBBSA has no obligation to use the Released Materials or to exercise any rights given by this Consent and Release Form. 

 

I hereby release BBBSA and its affiliates, employees, and agents, as well as any partner companies, from all claims, demands or liabilities and related financial costs that I may now or hereafter have arising in connection with BBBSA’s exercise of the rights hereby granted, and/or with the appearance or the Released Materials in any publication or production. These include, without limitation, claims for compensation, defamation, or invasion of privacy, or other infringements or violations of personal or property rights of any sort whatsoever.



Social Media Guidelines for Volunteers

“Social Media” is also called “social networking,” but this policy is to provide guidance on Mid Michigan Big Brothers Big Sisters expectations regarding the use of social media by its participants in an appropriate manner.


While Mid Michigan Big Brothers Big Sisters respects your privacy and your right to free speech, you also have responsibilities when you voluntarily put information into the public domain.  If you engage in conduct while using social media, as defined below, that is false, violates MMBBBS policies, is inflammatory, or constitutes violations of the privacy of others, you could be subject to immediate removal from the program and also personal liability.


Social Media refers to activities that integrate technology, social interaction and the sharing of words, pictures, videos and audio, such as”:

  1. Multimedia and social networking sites like Facebook, Twitter, Instagram, Snapchat, TikTok, YouTube, MySpace, and flickr.
  2. Social networking sites with an emphasis on professional exchange of information and development of business, such as LinkedIn;
  3. Blogs, microblogs, wikis, message boards, social bookmarking Web sites, and other community based sites or collaborative tools;
  4. Social commerce postings; like product or experience reviews and;
  5. Community based websites or selling pages
  6. Any other site where information (test, images, video, sound, or other files) can be uploaded or posted.


As a participant of Mid Michigan Big Brothers Big Sisters, your actions, speech, and statements whether in person, on the phone, in print, or online are reflective of our organization as a whole.  Before you post information online that relates in any way to MMBBBS or your “Match” please review and become familiar with the following guidelines.

  1. Think before you “send”.  Always remember to think about what you plan to say and how you plan to say it, before composing information and sending it out.  Once it is out there, it is difficult, if not impossible, to take it back, Do not communicate information when you are excited or angry.  You may not like what you sent when your mood has passed.
  2. Keep confidential information confidential.  Any statement, whether made online or offline or through images, videos, or sound files, related to or referencing MMBBBS’s mission, operations, staff, board members, Littles, Volunteers, or matches regardless of the media or form used must be approved by MMBBBS staff in writing.
  3. Be accurate, truthful, and considerate in your posts.  Be constructive, provide appropriate context, and think about the impact of your comments on your match, Little, Volunteer and MMBBBS. Be thoughtful about what your share and how you share it.
  4. Be respectful.  Respect for others is mandatory.  Do not post or share photos of your match, Little or Volunteer or statements about without the written approval of MMBBBS and parent/guardian, Volunteer permission.
  5. No privacy exists.  The internet is fully searchable, which means that anyone with an Internet connection, including your Match, MMBBBS, and the public can find even the most obscure information.  Be careful about posting personal information online, whether it is information about you, your match or MMBBBS.  Personal information includes photos, addresses and telephone numbers, information about where you are or where you have been with your match or anything else that could compromise your safety or that of your match.
  6. Consider possible legal ramifications.  Remember that individuals can be held legally accountable for comments deemed to be defamatory, slanderous, libelous, obscene, or proprietary, whether they pertain to MMBBBS, other organization or to your match, or an individual person.
  7. Identify yourself.  You must make it clear that you are speaking for yourself and not on behalf of the MMBBBS.  Speech that appears to represent MMBBBS, even remotely, takes on the appearance of an official position statement and is not permitted in any circumstance.  MMBBBS’s intellectual property, logos, trademarks, and copyrights may not be used in any manner.
  8. Communicate directly first. Remember that MMBBBS staff, volunteers, and parents/guardians rely on communication to identify and resolve issues.  If you have concerns about your match or MMBBBS procedures or conduct, please first contact staff directly, per signed ground rules, in attempt to resolve the matter.

Community Based or Site Based Plus                                                                  Mentor Ground Rules and Child Safety Guidelines                                                     

I UNDERSTAND THE FOCUS OF THE PROGRAM IS TO BUILD A POSITIVE RELATIONSHIP, AND BY AGREEING TO ACT AS A ROLE MODEL FOR THIS CHILD, THEREFORE I WILL: 


1.  This is a one-to-one match relationship.  I will avoid the inclusion of others during our match activities.

2.  Keep information that I may learn about my Little and his or her family confidential. I will show respect for the privacy of my Little and their family.

3.  Maintain regular contact with Big Brothers Big Sisters staff by responding to calls, letters, emails & text and by returning needed paperwork.

4.   Respect the personal space of my Little and avoid inappropriate physical contact.

5.  Wait three months to bring my Little to my home.  After three months, matches are encouraged to participate in MMBBBS group activities and activities in the community, but may visit the volunteer’s home with parental permission.

6.  Never leave my Little unattended or alone with any other person during match activities unless they are a fully screened volunteer or Big Brothers Big Sisters staff.

7.  Limit gift giving to special occasions, and will receive prior approval from the parent or guardian or agency staff

8.   Maintain open communication with my Little and their parent or guardian, always notifying parent/guardian about match activities and never asking my Little to keep a secret.

9.   Not arrange overnight activities with my Little.  Requests for exceptional circumstances may be submitted to the caseworker prior to activity for Executive Director consideration and approval.

10. Not contact my Little via the internet for the first six months of the match. 

11. Avoid disciplining my Little when we are together, leaving that responsibility to his or her parent.

12. Not approach school employees, counselors, doctors or others in concern of Little or their family without prior permission from their parent or guardian or agency staff. 

13. Disclose ownership of any weapons at enrollment and throughout the life of the match. I also agree to keep all weapons and ammunition safely stored while my Little is in my care.

14. Agree to volunteer a min. 4 hours per month for a min. of 1 year.  This is done with regular contact weekly/bi-weekly arranged with parent & child.

15. Notify Big Brothers Big Sisters staff immediately:

A)  Should MY contact information change or if a situation arises that may affect my match, including but not limited to serious illness, change in marital status, contact with law enforcement, etc.

B)  A problem or concern about the match or child arises.

C)  Should you suspect child abuse or neglect.  

16.   As a role model I will :

A)  Abstain from any use of alcohol, drugs, tobacco in the presence of my Little, or immediately prior to visit and I agree to avoid situations in which others are engaging in this type of activity.

B)  Not engage in activities activities that pose a risk of injury to my Little during match activities, such as speeding, not using seat belts, consuming alcohol or drugs, etc. 

C)  Keep my internet presence role model appropriate, including any information posted on social networking sites.


Site Based Mentor Ground Rules and Child Safety Guidelines                                

I UNDERSTAND THE FOCUS OF THE PROGRAM IS TO BUILD A POSITIVE RELATIONSHIP, AND BY AGREEING TO ACT AS A ROLE MODEL FOR THIS CHILD, THEREFORE I WILL: 


1.   Recognize that my match is one-to-one relationship and therefore, I will avoid the inclusion of

 others during our match activities.

2.   Keep information that I may learn about my Little and his or her family confidential. I will show respect for the privacy of my Little and their family.

3.   Maintain regular contact with Big Brothers Big Sisters staff by responding to calls, letters and e-mails.  I will also complete evaluations as requested by Big Brothers Big Sisters staff.

4.   Contact Big Brothers Big Sisters staff immediately if a problem arises in my match relationship.

5.   Notify Big Brothers Big Sisters staff should my contact information change or if a situation arises that may affect my match, including but not limited to serious illness, change in marital status, contact with law enforcement, etc.

6.   Actively participate in the closure procedure as requested by the Big Brothers Big Sisters staff when my match relationship comes to an end.

7.   Respect the personal space of my Little and avoid inappropriate physical contact.

8.   Limit gift giving to special occasions, and will receive prior approval from the parent or guardian or agency staff.

9.   Keep my internet presence role model appropriate, including any information posted on social networking sites.

10. Avoid disciplining my Little when we are together, leaving that responsibility to his/her parent.

11.  Agree to volunteer a minimum of weekly for a minimum of one school year.

12.  Notify my Little or the Big Brothers Big Sisters office prior to a scheduled meeting if unable to   keep the appointment.

13.  Refrain from the use of electronics during my time with my Little.

14.  Maintain match contact only at the mentoring site and/or designated meeting areas.

 

Application Acknowledgement

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.  

Contact Information