BBBS of Butler County Volunteer Application

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Non-Discrimination Policy

Children are not excluded on the basis of race, religion, national origin, color, gender, marital status of parent, sexual orientation, gender identity, veteran status or disability.

 

Volunteer Big Brothers, Big Sisters, Board Members, and Agency Staff as Volunteer Bigs are not excluded on the basis of race, religion, national origin, color, gender, marital status, sexual orientation, gender identity, veteran status, or disability.

ATTENTION PLEASE READ

This application is for adult volunteers only. If you are a high school student please contact us to complete the High School Big Application. Thank you!


info@bbbsbutler.org

Phone (513) 867-1227 (ext. 134) 

Text (513) 857-1491

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Contact Information


























Employer Information
























Additional Information










References and Background Check

Previous Experience












Volunteer Experience










Please provide at least three references below including:
  • Your spouse/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 one year
Spousal/Familial Reference







Professional Reference







Minimum 1 year
Personal Reference







Minimum 1 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.  















·        Provide verification of insurance coverage

 

·        Agree to supply this verification ANNUALY for the duration of their involvement with the agency as a volunteer

 

 

(Failure to comply with the request to provide annual insurance verification may result in termination of the volunteer’s match)

 

All volunteers must follow safety requirements in accordance with state law including:

 

·         Driver and all passengers must wear seat belt

 

·         Children under age 12 should ride in the backseat to prevent airbag injuries and fatalities. The airbag deploys in an angle that will injure or kill a child, so if they must ride in front, be sure you have an airbag turnoff switch.

 

·         If child weights under 40 pounds, he must ride in a booster seat. Boosters properly

position the seatbelt. Use a highback booster if the car’s backseat is below the

child’s ears.

 

·         If child is less than 8 years old, he/she must be in the back seat of the car and must use a booster seat unless 4 feet 9 inches or taller.

 

·         All drivers, under 18, are banned from using cell phones while behind the wheel

 

·         All other drivers, regardless of age, are banned from texting while driving

 

It is the policy of Big Brothers Big Sisters of Butler County to comply with the current Ohio Laws.

 

Confidentiality Policy to be read and signed by agency clients and volunteers 

ACCESS TO CONFIDENTIAL RECORDS

Big Brothers Big Sisters of Butler County 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 staff.  The right to confidentiality applies not only to written records, but also to video, film, and pictures.  The client or volunteer's name may be used in agency publications, such as the newsletter, unless a specific request is made to avoid this.

All records are considered the property of the agency and not the agency worker or clients or volunteers themselves.  Records are, therefore, not available for review by the clients or volunteers.

LIMITS OF CONFIDENTIALITY

Upon request by Law enforcement agencies or social service agencies, and at the discretion of the Executive Director,  information will be released to these agencies from the files of clients and volunteers.  A copy of the information released is placed in the client or volunteer's file.

Identifying information will not be made public except that names may be used in our agency newsletter.

For the purposes of program evaluation and other official duties, files may be opened to representatives of Big Brothers Big Sisters of America or United Way.

Members of the Board of Directors of Big Brothers Big Sisters of Butler County may also have access to files only in official capacities.

Big Brothers Big Sisters of America may be notified of incidents of child sexual abuse involving a program participant, whether a volunteer or a child.  The confidentiality of any such information is guaranteed by BBBSA and shall be shared only with appropriate professional staff and designated legal counsel.

If an agency worker receives information indicating that a client or volunteer may be dangerous to himself or herself or to others, necessary steps shall be taken to notify the local law enforcement authorities, after consultation with the Executive Director.  Referrals may also be made to appropriate social service agencies.

At the time a child or volunteer is considered as a match candidate, information is shared between the prospective match parties.  However, the identity of the prospective match mate shall not be revealed at this stage.  Names are shared with match mates only after the involved parties agree to the match.  Each match party shall have the right to refuse the proposed match based on the anonymous information provided.  The information to be shared may include any information gained by the agency which may prove helpful in determining the suitability of a match and contribute to its success.  Match parties are required to keep confidential the information learned in this interview.

In the interest of providing the best possible service, if any client, parent, or volunteer has a potentially life threatening and/or contagious disease, their involvement in the program will be evaluated by the Executive Committee and the Program Committee.  Any knowledge regarding a potentially life threatening and/or contagious disease that is gained by BBBS that might be helpful in determining the suitability of the match and contributes to its success or failure, may be shared with the prospective parties. (see BBBS application)  In the event that new information is obtained about the health of one of the parties involved in a match, and if that information is believed to be vital to the continuation of a match, BBBS will disclose this information to the other parties involved and take any necessary action, which may include terminating the match.

I have read and understood the above document which states the agency policy with respect to confidentiality of client and volunteer records.  I agree to program participation under the conditions it sets forth.

Permissions

I consent to and understand that:
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, 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 timely communication and follow-up with all agency staff.

Please read the following carefully before signing this application:

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, correct 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 on 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 occurrences.  I understand that BBBS staff needs to be fully informed to provide the best guidance or support possible.  

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.  

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