Volunteer Application

Thank you for DEFENDING POTENTIAL

Thank you for applying to volunteer or intern at Big Brothers Big Sisters Southern Lake Michigan Region!

The mission of Big Brothers Big Sisters is to provide children facing adversity with strong and enduring, professionally supported one-to-one mentoring relationships that change their lives for the better, forever. Big Brothers Big Sisters focuses on one-to-one mentoring relationships which help youth in the program build their self-esteem, foster stronger relationships, have higher aspirations, and set and achieve goals.

Even though you are not applying to become a Big, you are helping us to achieve our mission! We appreciate your willingness to help us in any capacity you are able.

Non-Discrimination Policy

Big Brothers Big Sisters Southern Lake Michigan Region follows a non-discrimination policy that prohibits exclusion of potential volunteer Bigs, youth, parents/guardians, board members, or agency staff on the basis of race, color, religion, age, pregnancy, gender, gender identity or expression, sexual orientation, national origin, ancestry, disability, veteran status, marital status, or any other protected class.

Hidden

Volunteer ID	Owner ID
Owner Email

Basic Information

First Name

Middle Name

If none input "N/A"

Last Name

Suffix

E.g. - Jr., Sr., II

Name Used (if different than Legal Name)

Maiden/Former Last Name

If not applicable, please input N/A.

Date of Birth

Input date format as dd/mm/yyyy

Gender

Please Specify Gender

Personal Pronouns

Other Pronouns

Preferred Language

Driver's License or State ID Required

Do you have a valid driver's license or state ID?

Upload Driver's License or State ID

Contact Information

Personal Email

Work Email

Preferred Email

Phone

Preferred Contact Method

Best Time to Contact You

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relationship

Home Address

Street Address

City

State

Zip Code

County:

Other states of residence in the past five years.

If you have not lived in any other states, please input N/A.

Check here if you have another address (dorm, etc).

Other Street Address

Other City

State

Other Zip Code

Student/Employment Information

Are you a student or employee?

Employer

Occupation

Employer Street Address

Employer City

Employer State

Employer Zip Code

School

Additional Information

How did you hear about us?

The above responses are entered immediately into our database so it must be the exact language listed. Would you mind being more specific about where you heard about us? For example, name of the Big who referred you, name of the event, etc. If you'd prefer not to say, simply type N/A. Thank you!!

Confidentiality Agreement

I thoroughly understand the need for confidentiality and I understand and acknowledge the following:

1. All information that I may encounter about any child, child’s family, Big Brother/Big Sister, the Big Brother’s/Big Sister’s family or anything else of a confidential nature about any child or volunteer in any way connected with Big Brothers Big Sisters WILL BE HELD CONFIDENTIAL.

2. Any information that reveals or tends to reveal the identity of any person who is the subject of the record WILL BE HELD CONFIDENTIAL.

3. The identity of any person who contributes information to the subject record WILL BE HELD CONFIDENTIAL.

4. The results of any inquiry into school records or medical records of any description WILL BE HELD CONFIDENTIAL.

5. I will NOT discuss any information that I am privileged to receive with any other person without the verbal or written permission of the program staff.

6. I will only release prior approved information to the individual to whom I have been given permission to release the information.

7. I agree to hold all related information confidential and, except as I may be legally required, I will NOT disclose or release it to any individual or corporation at anytime.

8. I understand that Big Brothers Big Sisters agrees to hold all related information confidential and, except as we may be legally required, we will NOT disclose or release it to any individual or corporation at anytime.

By clicking on the checkbox below, I am agreeing that I have read, understood, and agree to the Confidentiality Agreement.

I agree.

Social Security Number Agreement

The social security number will be collected by BBBS Staff during this process and entered automatically into the secure Match Force (MF) computer system provided to our agency by Big Brothers Big Sisters of America. The purpose of entering the social security number into the MF system is the following:

To verify that the social security number of the volunteer applicant does not match the social security number of any volunteer applicant previously determined inappropriate for volunteer service in the Big Brothers Big Sisters of America MF data system and to complete all necessary background checks upon beginning my volunteer experience and every three (3) years throughout my engagement with BBBS SLMR. If flagged by the MF system, an agency professional staff person will be alerted and will be required to follow up with the volunteer applicant within five (5) days to corroborate that the applicant is the same individual identified by the system. A copy of this agreement will be provided to all volunteer applicants upon request for their review. A social security number cannot be secured without the receipt of the signed release from the volunteer applicant providing the social security number. The signed release of the social security number (absent any written social security number) will be kept in confidential files.

Upon clicking the box below, I agree to willingly share my social security number with Big Brothers Big Sisters Southern Lake Michigan Region for the purpose of entry into the Big Brothers Big Sisters of America national Agency Information Management System data base in order to ensure that I have never been determined to be inappropriate for volunteer service to children by a Big Brothers Big Sisters’ agency member of Big Brothers Big Sisters of America network. I understand that the MF system is fully encrypted and is not available to any/all persons. I understand that any printed or digital copy of my social security number will be shredded/blacked out upon entry into the MF system.

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.

By clicking the checkbox below, I am agreeing that I have read, understood and agree to the Social Security Number Agreement.

I agree.

Participation Agreement

By UPON SUBMITTING THIS APPLICATION, 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 have provided may be used to conduct background checks, 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. Other BBBS agencies and youth organizations where I have worked or volunteered may be contacted as references.

5. I understand that the information I provide in the application process and throughout my volunteering experience will be kept confidential unless disclosure is required by law and with exceptions noted below.

6. I understand that incidents of child abuse or neglect, past or present, must be reported to proper authorities.

7. 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 my volunteering experience changes (i.e. address, phone number, new criminal charges, etc.).

I understand that this is an application for a volunteer opportunity and is not a promise or commitment by Big Brothers Big Sisters Southern Lake Michigan Region.

I certify that all information I have provided or will provide to Big Brothers Big Sisters Southern Lake Michigan Region, 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 Southern Lake Michigan Region. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant or my termination as a volunteer.

By clicking the checkbox below, I am agreeing that I have read, understood, and agree to the Participation Agreement.

I agree.

Electronic Signature

After clicking SUBMIT you will be prompted to sign and enter your email address. Then you will receive an email with a confirmation and a copy of this document. Thank you!