BBBS MI Capital Region Volunteer Application

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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. 

Hidden Fields




Basic Information




input NA if none










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File can be a screenshot, PDF, or picture
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 (biological or chosen) 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 will be contacted within 24 hours following the submission of my application. Contact will be made first via email. Additionally references can be completed over the phone. 
  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 on page 4), 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.
  13. If I am accepted and matched with a youth in Big Brothers Big Sisters, I will read and adhere to the Volunteer Code of Conduct at all times throughout my involvement with the program. 

Pre-Interview Questionnaire

Prior to your in-person or virtual 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.  

If unsure please leave this field blank
Community-Based Program- Bigs and Littles get together 2-4 times a month for a few hours each time at a time that is convenient for both the Big and the Little. The match can do activities they both enjoy like going to the park, making dinner together, play games, etc. This program does require the volunteer have a valid driver's license. 

Site-Based Program- BBBSMCR partners with a few area schools and the Big meets with their Little at their school. This type of match meets weekly on the same day during the lunch and recess time. This type of match can enjoy spending time playing games, reading, working on homework, etc. Site based matches are only permitted to meet at the site location and may not meet in the community.









Month and Year

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

If no one else resides in your home enter NA.

Release of Information Authorization for Background and Reference Checks

I authorize Big Brothers Big Sisters Michigan Capital Region to conduct a comprehensive investigation on any or all of the information and references I have supplied; this information may be used to conduct a background check, to include driving records, criminal background checks and other records. I consent to the release of such information and authorize my former employers, schools, and others reference to release information to BBBS and its representatives. I release from liability all persons, companies, educational facilities and corporations supplying suck information. 

Confidentiality  Policy

SAFEKEEPING OF CONFIDENTIAL RECORDS

 

The Executive Director is considered the custodian of confidential records.  It is his/her responsibility to supervise the management of confidential information in order to ensure safekeeping, accuracy, compliance with Board policy and accountability.  He/she shall assure that there are appropriate procedures that implement the confidentiality policy. 

 

ACCESS TO CONFIDENTIAL CLIENT AND VOLUNTEER RECORDS

 

In order for Big Brothers Big Sisters Michigan Capital Region (BBBSMCR) to provide a responsible and professional service to clients it is necessary for volunteers, clients, and parents/guardians of clients to be asked to divulge extensive personal information about themselves and their families. The agency respects the confidentiality of client and volunteer records and, with the exception of the situations below, shares information about clients and volunteers only among agency professional staff.  (Note: these files are handled by staff, both paid and volunteer.)  The right to confidentiality applies not only to electronic and hard copy records, but also to film, photos, and the use of client or volunteer’s name in agency publications.

 

All records, electronic and hard copy are considered the property of the agency and not the agency staff, clients or volunteers themselves.  Files are not to be removed from the agency without prior consent from Executive Director or Program Director.  Upon separation from the agency, BBBSMCR will immediately change passwords and deny access to agency files to terminated employees.

 

In order to provide a service that is in the best interest of the children served by the program, information from outside sources, including confidential references, must be assessed along with information gained from the clients or volunteers themselves.  Records are, therefore, not available for review by the clients or volunteers. 

 

Limits of Confidentiality

Information from client or volunteer records may be shared with the individuals or organizations specified below and under the following conditions:

 

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 (including photos, videos, etc.) 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 may need access to client and volunteer records.  These outside organizations shall be required to respect the agency policy on confidentiality.  Outside parties shall be required to use information only for the purposes(s) stated in the approved action of the Board of Directors.  Known violations of the agency’s 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 identify the person(s) to be authorized to review such records, the specific purpose for such review and the period of time during which access shall be granted.  Members shall be required to comply with the agency policy on confidentiality and use the information only for purposes stated by the approved 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’s legal counsel in the event of litigation or potential litigation involving the agency.  Such information is considered privileged information and its confidentiality is protected by law.

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

8.    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 protect the appropriate party.  This may include a medical referral or a report to the local law enforcement authorities.

9.    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.  Information that may be shared include:

Volunteer:  age, gender, race, employment, education, interests, personality “type”, experience with children, living situation, family history, habits/living patterns, motivation for volunteering.

Client:  age, gender, race, economic status, hobbies, living situation, school situation, personality “type”, family situation and health.

The client and volunteer shall have the right to review and approve the specific information before it is presented to the potential match mate, the individual to whom the information is provided shall agree in writing not to share the information with any other person.


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 Big Brothers Big Sisters Michigan Capital Region 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.

I have read this Consent and Release Form completely. I fully understand what it means, and I agree to its terms. I have not been offered any additional consideration or enticement, nor have I been coerced to sign this document. I am voluntarily signing it for the purposes and considerations described.


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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