Board of Directors Application & Background Screening Permission Form

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Personal Information

First Name

Middle or Maiden Name

Last Name

Date of Birth

Race

How do you Identify?

Sexual Orientation

Preferred Pronouns

Contact Details

Primary Phone

Primary Email

Mailing Address

City

State

Zip Code

Parish

Employment Information

Employer

Job Title

Employer Address

Employer City

Employer State

Employer Zip Code

Employer Parish

Number of years are present employer

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As a new or prospective volunteer of Big Brothers Big Sisters of Southwest Louisiana, I understand that the Calcasieu Parish Sheriffs Dept., the Louisiana State Police and the FBI will conduct a thorough investigation of any record of past criminal activities. I understand and authorize the investigation to be conducted annually and reported directly to Big Brothers Big Sisters of Southwest Louisiana.

During the application process and at any time during the period of volunteering with Big Brothers and Big Sisters of Southwest Louisiana, by my signature below, I hereby authorize such an investigation and further authorize the Calcasieu Parish Sheriffs Dept., the Louisiana State Police, the FBI, and Choice Point Services, Inc. to release all criminal record information maintained in their files, which may confirm or deny any eligibility for volunteerism with Big Brothers and Big Sisters of Southwest Louisiana.

Motor Vehicle Report Authorization

I also hereby authorize Choice Point Services Inc., on behalf of Big Brothers and Big Sister s of Southwest Louisiana to procure a Motor Vehicle Report annually. This report may be compiled with information from courts record repositories, past or present employers and educational institution s, governmental occupational license or registration entities, business or personal references, and any other source required to verify information that I have voluntarily supplied.

I consent to the preparation and release of background reports to Big Brothers Big Sisters of SWLA and its designated representatives.

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BBBS of Southwest Louisiana 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. 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. Big Brothers Big Sisters of America and its affiliates will have access to an individual’s information without written consent.

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

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

4. 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.

5. 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.

6. Information shall only be provided to the agency’s legal counsel in the event of litigation or potential litigation involving the agency.

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

8. State law mandates that suspected child abuse be reported to the State of Louisiana Department of Social Services Office of Community Services Children Youth and Family Services at 800-814-1584.

9. 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 local law enforcement authorities.

10. 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, etc. Information about the child may include but not be limited to 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.

Social Media Guidelines for Volunteers

Social Media

Give the parent/guardian and BBBS of SWLA your website address and, when possible, link your page to the BBBS of SWLA page on that site so that we can follow along with your postings. We are active on Facebook and Twitter.

Never post any pictures of your Little online unless you have the written consent of the child’s parent/guardian. Check with your BBBS Case Manager as that consent form should be filed with the agency.

Never post the last name of your Little, his parent/guardian or BBBS of Southwest Louisiana staff.

Never post any contact information for your Little.

Never post any identifying information or contact information for your Little (i.e. child’s address, school the child attends, telephone numbers, parent’s workplace).

Never post anything that can be perceived as judgmental or offensive to your Little or his/her parent/guardian.

Volunteers must not tag Littles in any photos posted to social media or make any reference to the Little’s profile. Littles must not tag themselves in photos posted to social media by their volunteer Big.

Be aware of other postings on your page that are not BBBS of SWLA related or are inappropriate for minors. Know that as a BBBS volunteer you are a role model at all times. Please ensure that all contents are appropriate and kid-friendly, in case your Little or his/her family were to read your social networking page.

I consent to use images and consent to use my name in promotional materials for Big Brothers Big Sisters of America.

I do not consent to use images and consent to use my name in promotional materials for Big Brothers Big Sisters of America.