Big Brothers Big Sisters of Southern Arizona Mentor 2.0 BIG Application

Thank you for starting your first steps with Big Brothers Big Sisters of Southern Arizona!

Now that you have attended orientation, and learned how to become a great BIG with our Mentor 2.0 program, we'll just need some information from you to process everything on our end. Here are a few items to keep in mind before proceeding with your application:

At the end of this form you will be prompted to e-sign. You will then verify via a link sent to your email. Your application will be considered incomplete until you verify using that link.
Once you press submit on the application, you will be redirected to our Mentor 2.0 Interview Calendar to schedule your next step. If you need any accommodations feel free to reach out.
We will be asking you to provide a few items on this application. Please take a minute to have your Car Insurance Card, Driver's License, and Personal and Professional References ready for the application.

If you have any questions or concerns please feel free to contact our Mentor 2.0 Program Manager at 520-365-2852 or email susanc@soazbigs.org

Contact Information

Personal Email

Work Email

Alternate Email

Preferred Email

Mobile Phone

Work Phone

Work Phone Extension

Preferred Phone

Home Phone

Alternate Phone

Best Time to Call

In general, do you prefer to be contacted by email or phone?

Address (Please list your physical address, as this will be used to make your match)

Street Address

City

State

Zip Code

Emergency Contact Information

Name

Phone

Relationship

Employer Information

Occupation

Name of Employer

Job Title

Annual Household Income

References and Background Check

Previous Experience

Have you previously applied to be or served as a Big here or anywhere else?

YesNo

When?

Where?

Have you ever been involved with Big Brothers Big Sisters in a capacity other than a Big?

YesNo

When?

Where?

Have you ever been denied acceptance or released from service as a volunteer or employee or another Big Brothers Big Sisters Program for another youth-serving organization?

YesNo

When?

Where?

Have you ever actively volunteered or worked with youth before as a Big or otherwise?

Volunteer Experience

YSO Reference ID

Organization Name

Location

Start Date

End Date

Direct Supervisor First Name

Direct Supervisor Last Name

Phone

Email

Years Known

Reason for Leaving

Please list at least TWO references who you have known for at least ONE year, who can comment on your character and/or experience with children. Before inputting your references, please read the guidelines below.

You must include ONE professional reference and ONE personal references
If you are married or in long term relationship, YOU MUST LIST YOUR PARTNER. If you have neither list a family member.
If you are ACTIVE IN THE MILITARY, one reference must be your commanding officer

Spousal/Familial Reference

Spousal/Familial Reference ID

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Professional Reference

Professional Reference ID

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Minimum 1 year

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.

Do you have any concerns about your ability to fulfill the one year commitment of becoming a mentor?

YesNo

Please describe:

Write if NA if no details are needed

Have you ever been accused, arrested, charged, or convicted of a crime?

YesNo

Please describe:

Write if NA if no details are needed

Have you had any driving citations and/or moving violations in the past five years?

YesNo

Please describe:

Write if NA if no details are needed

Have you ever been terminated or otherwise disciplined, placed on probation, or warned not to continue engaging in certain conduct while volunteering with any agency (whether or not youth were involved?) *

YesNo

Do you have any any additional experience you would like the BBBSSA team to know? If so, please include additional details.

Mandated Reporting, PLEASE READ THOROUGHLY

While it is not very common, it is possible that you or your Match Support Specialist may become concerned for the safety of your little. You may be concerned that he or she is being abused physically, emotionally or sexually. You may be concerned that your little is neglected. You need to immediately discuss any concerns you have with your Match Support Specialist.

All volunteers working with children are considered “Mandatory Reporters” under Arizona State Law.

What does the law say?

Any person who reasonably believes that a minor is or has been the victim of physical injury, abuse, child abuse, a reportable offense or neglect that appears to have been inflicted on the minor by other than accidental means…shall immediately report or cause reports to be made of this information to a peace officer or to child protective services in the department of economic security, except if the report concerns a person who does not have care, custody or control of the minor, the report shall be made to a peace officer only.

A person who furnishes a report … is immune from any civil or criminal liability …unless the person acted with malice or unless the person has been charged with or is suspected of abusing or neglecting the child or children in question.

A person (Mandatory Reporter) who violates this section is guilty of a class 1 misdemeanor except if the failure to report involves a reportable (sexual) offense, the person is guilty of a class 6 felony.

Please check off the following agreements. You will have a chance to electronically sign off at the end of this form.

I understand that as a Big Brother/Big Sister, I am a Mandatory Reporter for suspected child abuse.

I understand that as a Mandatory Reporter, if I reasonably believe that a minor is or has been the victim of abuse I shall immediately report or cause reports to be made of this information to a peace officer or to Department of Child Safety.

If I believe my Little Brother/Little Sister is in immediate danger I will call local law enforcement (911).

I agree to comply with the Mandatory Reporting law by immediately reporting my concerns to my Match Support Specialist or the Program Director during business hours at 520-624-2447. I understand that my Match Support Specialist will then make the report. I can also report my concerns to the Department of Child Safety (1-888-SOS-CHILD) 24/7 or to local law enforcement.

If concerns arise and I am not able to immediately speak with Big Brothers Big Sisters of Southern Arizona (BBBSSA) staff, I will report my concerns to DCS or local law enforcement.

I will inform BBBSSA of any reports I have made to DCS or law enforcement.

I understand that it is not my job to investigate my suspicions. If a child discloses abuse or fear of abuse, I will remain calm and not probe for details.

I understand that I must not confront a family member with my suspicions or concerns.

I understand that BBBSSA staff are also mandatory reporters and will be discussing child safety with myself, my Little and the Little's parent or guardian throughout the match.

Release of Information Authorization for Background Check

All incoming volunteers must pass a Background Check test in order to be fully accepted into the program. All information in this form will remain secure and confidential and only be shared with our Background Check company.

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

Preliminary Information

Please use your the information on your Driver's License to fill out the following information so we can process your background check successfully.

Username

Password

Account

ProfileID

ClientReferenceID

First Name

Middle Name

Last Name

Maiden Name

Social Security Number

9 DIGITS WITH NO PUNCTUATION Ex: 000000000

Date of Birth

FORMAT IS MM/DD/YYYY

Gender

Driver's License Information

Driver's License Number

Driver's License State

Driver's License Expiration Date

FORMAT IS MM/DD/YYYY

Contact Information

Email Address

Phone Number

Country

Address Line 1

Address Line 2

City

State

Zip Code

Uploads

Please upload a copy of your license

File can be a screenshot, PDF, or picture

Auto Insurance Company

Auto Insurance Effective Date

Please upload a copy of your auto insurance.

File can be a screenshot, PDF, or picture

Child Safety Policies

Incoming volunteers must complete a short child safety training portion. All we will need from you is to click the link below that contains your full Volunteer Guide. This will serve as your resource hub, and introduce you to the full program. Once you are done reading through this PDF, please check off the following statements to show agreement. You will have a chance to electronically sign off a the end of this form. If you wish to save and resume this form at a later time to give you ample time to read through it, please feel free to do so using the top center checkbox that says "Save my progress and resume later"

Volunteer Guide: CLICK HERE AND READ THROUGH YOUR GUIDE

Do you acknowledge that you have read through BBBSSA's child safety training? (Located on Page 5 of your volunteer Guide)

Yes, I acknowledge that I have read through and completed BBBSSA's child safety training

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.

I have answered these questions honestly and completely to the best of my knowledge.

You have reached the end of the application, please press Review and Sign below and follow the instructions so that our staff receives your application in full.

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
Pacific Islander - Chamorro	Pacific Islander - Native Hawaiian
Pacific Islander - Other	Pacific Islander - Samoan
White or Caucasian	Other
Prefer not to say

African Languages (Swahili, Bantu)	American Sign Language
Arabic	Asian: Other
Chinese	Creole
Dutch	Eastern European (Czech, Slovak)
English	French
German	Greek
Hebrew	Hmong
Indian (Hindi, Punjabi)	Italian
Japanese	Keres (West)
Korean	Lao
Nordic	Persian
Portuguese	Russian
Spanish	Turkish

Big Brothers Big Sisters of Southern Arizona Mentor 2.0 BIG Application

References and Background Check

Questionnaire

Interests

Mandated Reporting, PLEASE READ THOROUGHLY

Please check off the following agreements. You will have a chance to electronically sign off at the end of this form.

Release of Information Authorization for Background Check

Child Safety Policies

Volunteer Guide: CLICK HERE AND READ THROUGH YOUR GUIDE

Application Acknowledgement

You have reached the end of the application, please press Review and Sign below and follow the instructions so that our staff receives your application in full.