BBBS Volunteer Application

Non-Discrimination Policy

Our participants come to us with a wide range of personal characteristics. We believe that participant eligibility shall be determined without regard to race, color, religion, national origin, gender, marital status, sexual orientation, gender identity, veteran status, or disability. 

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Basic Information




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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 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
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.  
  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.

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.  






Agency Weapons Policy

Firearms / Weapons Policy 

 All volunteer applicants will be asked, during their interview or home visit, if they possess a firearm or any other dangerous weapon.

 

A dangerous weapon is defined as any “tool, instrument or device, which is able or likely to inflict harm or injury to an individual” including, without limitation, all firearms, handguns, rifles, knives (other than knives commonly used for dining), tasers/stun guns, and explosives including fireworks.

 

If the applicant possesses a firearm, the applicant must demonstrate that he/she is in compliance with all applicable safe-storage laws, and that the firearm is stored with a trigger-locking mechanism, separately from ammunition, and kept in a locked location that is inaccessible to children. Under no circumstances is the volunteer to carry a weapon of any kind in his/her automobile during match outings.

 

BBBSSADK explicitly prohibits all volunteers from involving a Little in an activity that involves a dangerous weapon. Activities such as hunting, target shooting, paint ball games, or the use of BB or pellet guns are prohibited.

 

Volunteers who have firearms will be asked to sign the Weapons Agreement Form specifying their commitment to following this policy. If a volunteer does not agree to the policy as it relates to firearms in the home, a limitation will be placed on the match, denying approval for the child to visit the volunteer’s home.  This limitation will be documented in the match agreement.  If the volunteer does not agree to comply with the firearm policy as it relates to carrying a firearm in the automobile, the volunteer will be denied. 

 

If the volunteer is a law enforcement officer required to carry a weapon at all times, an exception will be made as long as the Parent / Guardian(s) is notified, and this signed consent form is on file.









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


Release of Information Authorization for Background Check

I hereby authorize Big Brothers Big Sisters of the Southern Adirondacks, Inc to make an independent investigation of my background, criminal or police records, including those maintained by both public and private organizations and all public records for purpose of confirming the information contained on this consent form and/or obtaining other information which may be material to my qualifications for employment or volunteer purposes.

 

I release Big Brothers Big Sisters of the Southern Adirondacks and/or agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or lawsuits in regards to the information obtained from any and all of the above referenced sources used.

 

The following is my true and complete legal name and all information is true and correct to the best of my knowledge:


Confidentiality and Digital Platform Policies

In order for Big Brothers Big Sisters of the Southern Adirondacks, Inc to provide a responsible and professional service to clients, it is necessary for volunteers, clients and parents or guardians of clients to be asked to divulge extensive personal information about themselves and their families. The agency respects the confidentiality of clients and volunteer records, and, with the exception of 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 or use of any client or volunteer’s name in agency publications.

 

All records are considered the property of the agency and not the agency workers or clients or volunteers themselves.  In order to provide a service, which is in the best interest of the children served by the program, information from outside sources, including confidential references, must be assessed along with the information gained from the clients or volunteers themselves.  Records are not available for review by the clients or volunteers.  Clients and volunteers shall be provided, at the time of application, a copy of this statement on confidentiality along with the exceptions that define the limits of confidentiality.  Clients and volunteers shall sign a statement that he/she has to read and understand the agency policy on confidentiality and agree to program participation under the guidelines it sets forth.

 

Limits of Confidentiality

1.  Information will be released to other individuals or organizations only upon presentation of an authorized “Consent to Release 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 if the client or volunteer has given permission.

 

3.  For purposes of program evaluation, audit or accreditation, and with the prior approval of the Board of Directors, certain outside bodies such as the Big Brothers Big Sisters of America may have access to client and volunteer records.  These outside organizations shall be required to use the information only for the purpose(s) stated in the approval action of the Board of Directors.  Known violations of agency confidentiality policy will be reported to the supervisor of the individual involved and appropriate disciplinary action shall be requested.

 

4.  Members of the Board of Directors have access to client files only upon authorization by formal motion of the Board of Directors.  The motion shall state who shall be authorized to review records, the specific purpose for such a review, and the period of time during which access shall be granted.  The member shall be required to comply with the agency policies on confidentiality and may use the information only for purposes stated by the approval action of the Board of Directors.  Known violations shall be reported to the Board President.  A violation of the agency’s confidentiality policy by a Board Member shall constitute adequate cause for removal from office.

 

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

 

6.  Information shall be provided to an agency legal counsel in the event of litigation or potential litigation involving the agency.  Such information is considered privileged information and law protects its confidentiality.

 

7.  State law mandates that suspected child abuse be reported to the appropriate authorities (designated state agency).  All workers are responsible for staying abreast of such reporting requirements of their respective jurisdiction and shall always comply with mandated procedures.

 

8.  If any 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 person.  This may include a medical referral or a report to local law enforcement authorities.

 

I have read and understand 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.

 

I agree to keep information discussed with me regarding a potential (Big Brother/Sister, Little Brother/Sister) match confidential.  I will not discuss this information with any person other than the assigned professional staff of the Big Brother Big Sister agency.



Big Brothers Big Sisters of the Southern Adirondacks recognizes that online social networking

(Facebook, Instagram, Twitter, LinkedIn, Blogs, etc.) has become a very popular communications tool and that

many of our Bigs and Littles use these websites. Not all social networking sites are designed to support mentoring

relationships. If you do choose to participate in a social networking site, you must adhere to the following guidelines:

• BE RESPONSIBLE. Be thoughtful about how you present yourself and the BBBS organization.

Be aware of other postings on your page that may be inappropriate.

• BE RESPECTFUL. Make sure that what you post will add a positive to the discussion and not a

negative. It is okay to disagree with others, but being rude or disrespectful is inappropriate.

Remember everything posted is public. Never post anything that could be perceived as offensive

or judgmental.

• BE RESOURCEFUL. Add value and spread the news about BBBS. Share events or posts from

the BBBS social media accounts. Help build a sense of community. Participating in social media

gives you the opportunity to share a lot of valuable information.

• BE SMART. Use your best judgement when deciding what information to publish or spread.

Know that there are consequences to what you publish. What you write could spread virally and

will be public for a long time. It can be attributed to you and BBBS. Be respectful to the

organization, staff, volunteers, children, families, donors, partners, and supporters. Do not post

photo or video materials of the match on media that cannot be set to private.

• RESPECT PRIVACY OF OTHERS. Protect confidences and personal privacy. Only share

information through social media that you know is appropriate for public consumption. Get

approval before sharing information relayed to you by others. Always adhere to policies and

ground rules related to confidentiality and child safety. Never post names or contact information

about one another. Never post identifying information, such as home address, school, work, etc.

• BE THE FIRST TO RESPOND TO YOUR OWN MISTAKES. Make sure that what you say is

factually accurate. Clarify information that is incorrectly communicated and take responsibility if

you are responsible for misstating facts.

• REPORTING PROCESS: If anyone within the match shows social media misuse or content that

may endanger the Little’s health, safety, or well-being should contact Agency Staff immediately.

Agency Staff will review on a case-by-case basis and take appropriate action. BBBS

recommends to have no social media interaction within your match.


Virtual Platform


Media Consent and Release

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 America and [BBBSA affiliate] 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 other 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.

Child Safety Guidelines and Ground Rules for Volunteers                                                                      

Please read these guidelines carefully.  If you have any questions or concerns, please discuss them with your Enrollment Specialist.  Violation of these standards can lead to closure of your match.

 

1.     Do not use alcohol or drugs, including tobacco when you are with your Little. 

 

2.     Always be sure that your Little wears a seat belt while traveling in a car.  Don’t allow your Little to ride with others.

 

3.     Never take a child on a motorcycle, hot air balloon ride, etc.

 

4.     Volunteers must maintain a valid license and auto liability car insurance for the duration of the match.

 

5.     It is imperative that you discuss any suspicions of child abuse or neglect with your Case Manager immediately.

 

6.     It is never acceptable to use corporal punishment on your Little, even if the parent gives you permission to do so.  Discuss other methods of boundary setting with your Case Manager.

 

7.     Never tell your Little anything or ask your Little to do anything that he/she would have to keep a secret.  (An exception would be a surprise gift for someone).

 

8.     Drop your Little off with his/her parent or, if pre-arranged, with another adult.  If an adult is not present when you’re dropping off your Little, please contact the emergency contact.

 

9.     Keep guns locked or inaccessible to your Little in accordance with BBBSSADK Gun Safety Policy. 

 

10.  Please be advised that volunteers are “At-Will” volunteers.  This means that the volunteer or the agency can terminate the relationship at any time, for any reason.

 

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