Big Brothers Big Sisters of Tampa Bay Volunteer Application

Welcome and Non-Discrimination Policy

Thank you for applying to be a Big in the Big Brothers Big Sisters of Tampa Bay mentoring program. Once you submit the application we will be in contact within 2 business days to give you additional information and talk to you about next steps in the process.

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.

Contact Information

Personal Email

Work or Alternate Email

Preferred Email

Mobile Phone

Work Phone

Work Phone Extension

Home Phone

Alternate Phone

Preferred Phone

Best Time to Call

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

Mailing Address

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

Mailing Country

Mailing address is different from residential address

Physical Address

Street Address

City

State

Zip Code

Country

Emergency Contact Information

Name

Phone

Relationship

Are there other adults who live with you?

YesNo

To ensure safety, our process includes a basic screening of other adults living in a volunteer's home. Please list the full name, other names used (maiden, alias, etc.), and birth date of ALL adults 18 year or older living in your home:

Name

Birth Date

Employer Information

Occupation

Name of Employer/School

Employment Length (Months)

Employment Length (Years)

Employer Address Line 1

Address Line 2

City

State

Postal Code

Is it okay to call at work?

YesNo

Previous Experience

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

When?

If yes, please explain.

Where?

References and Background Check

Please provide at least three references. A reference from a Spouse/Spousal Equivalent or Significant Other is required. Substitute a family member if no Spouse/Spousal Equivalent or Significant Other. Must have known reference for at least one year.

Spousal/Family Member Reference

Spousal/Family Reference ID

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Professional or Personal Reference

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Personal Reference

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Have you held a volunteer or paid position where you worked with children in the last five years? (for example counselor at a camp, babysitting, nannying, coaching, etc.)

Volunteer Experience

Organization Name

Location

Start Date

End Date

Direct Supervisor First Name

Direct Supervisor Last Name

Phone

Email

Years Known

Reason for Leaving

I understand that:

The references and youth organizations that I have worked for or been involved with as a volunteer whose information I have provided may be contacted by telephone or email.
I am in no way obligated to perform any volunteer services.
I will be asked to provide my social security number.
I will need to be fingerprinted.
The information I provide may be used to conduct a background check, to include a driving records check, criminal background check, and other records where required by local, state, or federal law for volunteers working with youth. If matched, the information I provided may also be used to conduct an annual criminal background and driving records check. Continued involvement will be based on the information discovered.
Big Brothers Big Sisters has the right to accept or deny program participants and is not obligated to match me with a youth. Big Brothers Big Sisters is not required to provide me with a reason if I am not accepted or matched with a youth.
As part of the enrollment process, I agree to provide additional personal information to assist Big Brothers Big Sisters in making a recommendation for matching.

I accept the terms and conditions

Virtual Platform

Big Brothers Big Sisters of America has developed a digital platform to help Bigs and Littles stay in touch more easily in a safe and secure way. Participation requires your permission.

I consent, should I be matched, to having contact with my Little through Big Brothers Big Sisters' digital platform (if available).

Confidentiality Policy

Big Brothers Big Sisters of Tampa Bay (BBBS) respects the confidentiality of Client and Volunteer records and with the exception of situations listed below, shares information about Clients and Volunteers among the agency’s professional staff only. All records are considered the property of the agency and not the agency Employees, Clients, or Volunteers themselves. Records are not available for review by the clients or the volunteers.

1. Information will be released to other individuals with non-BBBS organizations only with written consent from the Client or the Volunteer.

2. Identifying information regarding Clients and Volunteers may be used in agency publications or promotional materials unless the client or volunteer requests otherwise.

3. 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 (BBBSA) may have access to Client and Volunteer records.

4. Members of the Board of Directors or evaluators appointed by the Board have access to Client files upon the authorization of the Board of Directors.

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.

7. State law mandates that suspected child abuse be reported to the appropriate authorities (Florida Department of Law Enforcement).

8. If an agency Employee 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/parties involved. This may include a medical referral or 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. Information about the Volunteer may include such items as: age; sex; race; religion; interests; hobbies; marital and family status, sexual orientation; living situation; etc. Information about the child may include such items as age; sex, race; religion; interests; hobbies; family and living situation; etc.

10. Confidentiality policy is applicable to all forms of social media including but not limited to blogs, Twitter, Wiki, chat rooms, forums, and online social networking sites such as LinkedIn, Facebook, and MySpace, and any other form of online publishing or discussion, whether such media exists now or in the future. Volunteers must keep all forms of social media set to private and any sharing of information must be approved by Parent/Guardian and age appropriate for the child to view. To ensure child’s safety, Big Brothers Big Sisters requests that all interaction via social media be reported to Match Support Specialist . Volunteer cannot post pictures or any identifying information on any form of social media without Parent/Guardian approval.

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.

Media and Talent Release for Volunteers

I irrevocably consent to any and all uses and displays of my name, image, likeness, appearance, and basic biographical information in, on, or in connection with any advertising, publicity, marketing, or printed or electronic media, of any type, throughout the world at any time by Big Brothers Big Sisters of America, BBBS of Tampa Bay, and/or any other Big Brothers Big Sisters entity, and any of their affiliates, successors, partners, sponsors, donors, and any entities or persons with whom they conduct any public relations, marketing, or fund raising of any type, without further consent from me or without any royalty, payment, or other compensation to me, without any royalty, payment, or other compensation to me or Minor Child, and with the release and waiver of any claims, actions, damages, losses, costs, expenses and liability of any kind arising from any such use.

Please Choose One:

I AgreeI Disagree

American Indian or Alaska Native	Asian - Indian
Black or African American	Pacific Islander - Chamorro
Asian - Chinese	Asian - Filipino
Hispanic - Cuban	Hispanic - Mexican,Mexican American,Chicano
Hispanic - Other Latinx or Spanish origin	Asian - Japanese
Asian - Korean	Middle Eastern or North African
Pacific Islander - Native Hawaiian	Other
Asian - Other	Pacific Islander - Other
Pacific Islander - Samoan	Asian - Vietnamese
White or Caucasian

Spanish	African Languages (Swahili, Bantu)
American Sign Language	Arabic
Asian: Other	Chinese
Creole	Dutch
Eastern European (Czech, Slovak)	French
German	Greek
Hebrew	Hmong
Indian (Hindi, Punjabi)	Italian
Japanese	Keres (West)
Korean	No Preference
Nordic	Persian
Portuguese	Russian
Turkish	Lao