BBBSNS - 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

Contact ID 18 Character

Enrollment ID 18 Character

Contact Owner ID

Contact Owner Email

Basic Information

First Name

Middle Name

Last Name

Maiden/Alias

input NA if none

Preferred Name

Birthdate

Social Security Number

*If you are under 18 y.o., please enter: "000000000"

Gender

Personal Pronouns

What pronouns do you use?

Race/Ethnicity

American Indian or Alaska Native	Asian - Chinese
Asian - Filipino	Asian - Indian
Asian - Japanese	Asian - Korean
Asian - Other	Asian - Vietnamese
Black or African American	Hispanic - Cuban
Hispanic - Mexican,Mexican American,Chicano	Hispanic - Other Latinx or Spanish origin
Hispanic - Puerto Rican	Middle Eastern or North African
Pacific Islander - Chamorro	Pacific Islander - Native Hawaiian
Pacific Islander - Other	Pacific Islander - Samoan
White or Caucasian	Other
Prefer not to say

Tribal & Regional Corporation Affiliations

Nationality

To select multiple, hold CTRL/CMD and click.

Do you have a driver's license?

Driver's License Number

Driver's License State

Driver's License Expiry

Please upload a copy of your license

File can be a screenshot, PDF, or picture

Auto Insurance Effective Date

Auto Insurance Company

Please upload a copy of your auto insurance.

File can be a screenshot, PDF, or picture

Auto Insurance Policy Duration:

Contact Information

Personal Email

Work Email

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 address is different from residential address

Physical Address

Street Address

City

State

Zip Code

Emergency Contact Information

Name

Phone

Relationship

Are you under 21 years of age?

This determines which program formats you are eligible to participate in.

Employer Information

Employment Status

Name of Employer

Name of Former Employer

Occupation

Employment Length (Months)

Employment Length (Years)

Employer Address Line 1

Address Line 2

City

State

Postal Code

What is your work/school schedule?

Is it okay to call at work?

YesNo

Additional Information

In which BBBSNS service area are you interested in being matched?

Of the locations listed, which region is closest to home?

How far are you willing to drive to pick up your Little? (If over 21 y.o.)

Level of Education

Education Years Completed

What school(s) did you attend?

Have you served in the military?

Dates of Service:

From:

To:

What were the job positions held and duties performed?

What was the character of your discharge from the service?

Have you been deployed?

YesNo

Are you currently deployable?

YesNo

How would you describe yourself, in terms of participation in events, activities, or sports?

Which type of activities do you enjoy more?

How did you hear about Big Brothers Big Sisters?

Referral Detail ID (map from dynamic picklist how did you hear about us)

What attracted you to BBBS as a way of becoming involved in working with youth?

How does this volunteering opportunity fit with your personal goals?

References and Background Check

Previous Experience

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

YesNo

When?

Where?

Have you ever been involved with Big Brothers Big Sisters in a capacity other than a Big?

YesNo

When?

Where?

Have you ever been denied acceptance or released from service as a volunteer or employee or another Big Brothers Big Sisters Program for another youth-serving organization?

YesNo

When?

Where?

Have you ever actively volunteered or worked with youth before as a Big or otherwise?

Volunteer Experience

YSO Reference ID

Organization Name

Location

Start Date

End Date

Direct Supervisor First Name

Direct Supervisor Last Name

Phone

Email

Years Known

Reason for Leaving

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.

If you are under 21 years-old:

Please list your parent/guardian under Familial Reference
Please list someone from your school if you are a student (teacher, administration, counselor); OR someone in the workforce that you have known for at least one year.
A friend or neighbor you have known for at least two years.

Spousal/Familial Reference

Spousal/Familial Reference ID

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Professional Reference

Professional Reference ID

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Minimum 1 year

Personal Reference

Personal Reference ID

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Minimum 2 years

I consent to and understand that:

The references and youth-serving organization(s) I listed may be contacted by mail, telephone, email, or in person;
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;
I am in no way obligated to perform any volunteer services;
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;
Other BBBS agencies and youth organizations where I have worked or volunteered may be contacted as references;
As part of the enrollment processes, I will be required to provide additional personal information, including completion of an in-person interview;
I understand that the information I provide in the enrollment process will be kept confidential, unless disclosure is required by law.
I understand that detailed accounts of child abuse or neglect, past or present, will be reported to proper authorities;
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);
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.)
I agree to complete questionnaires throughout my time in the program to evaluate and improve program services;
I agree to timely communication and follow-up with all agency staff as required by the agency.

I accept the terms and conditions

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.

Do you have any concerns about your ability to fulfill the one year match commitment required of mentors?

YesNo

Do you anticipate any significant life changes over the next year or have you had any this past year? (ie. job or schedule changes, moving, new family member, etc.)

YesNo

Please describe:

Have you ever been accused, arrested, charged, or convicted of a crime?

YesNo

Please describe:

Have you had any driving citations and/or moving violations in the past five years?

YesNo

Please describe:

Do you have guns, ammunition, or other weapons in your house?

No GunsGuns Secured

Agency Weapons Policy

I agree to keep any weapons and ammunition inaccessible to the child assigned to me by BBBS while he/she is in my custody, unless on a specifically approved match activity, as described above.

What languages do you speak fluently? (select all that apply)

African Languages (Swahili, Bantu)	American Sign Language
Arabic	Asian: Other
Chinese	Creole
Dutch	Eastern European (Czech, Slovak)
English	French
German	Greek
Hebrew	Hmong
Indian (Hindi, Punjabi)	Italian
Japanese	Keres (West)
Korean	Lao
Nordic	Persian
Portuguese	Russian
Spanish	Turkish

Relationship History

Do you have any siblings?

YesNo

Where did you grow up?

What did your parents/guardians do for a living?

How would you describe your current relationships with your parents/guardians, siblings, and/or other family members?

Relationship Status

How did you meet?

How long have you known each other?

Is there anyone whom you share your residence with? (i.e. spouse, children, roommate, etc.)?

YesNo

Please provide the name, age, and relationship of all individuals residing in your household:

Name

Relationship

Birthdate

Home Assessment

On a scale of 1-10 (with 10 being very safe), how would you rate the safety of your neighborhood?

Would a youth generally enjoy being around your home? Why or why not?

How long have you lived in the community?

Is there any chance you could be moving out of the community?

YesNo

What are some activities you can envision doing with your Little in your home?

Would you be able to make inappropriate viewing material in your home unavailable for a child?

YesNo

Do you have any pets?

Yes

What kind of pet(s)?

Are they up to date on their vaccinations?

YesNo

Are you able to put the animal away when the child is present?

YesNo

Both in and around your home, what do you think are some of the safety considerations you will have to take into account?

Previous Residences

Have you lived in any other countries or states aside from you current address in the past 5 years?

YesNo

City/State

From

Experience with Children

Do you have any experience with children (other than that of raising children)?

Yes - VolunteerYes - PaidNo

What were the ages of the youth you worked with?

How long did you work/volunteer? (Hours/Week)

What did you learn?

What did you enjoy most about working with children? What challenges did you face?

What qualities do you admire most in children?

Volunteer Match Preferences

What is the youngest and oldest age you see yourself working with?

Do you imagine yourself with a talkative child, or one who is on the quieter side?

Do you imagine yourself with a child who asks for your advice, or prefers to work things out on their own?

Please list a few activities you can envision participating in with your Little:

Are you willing to work with a child who has a mental health diagnosis? (i.e. depression, PTSD, etc.)

Would you be willing to be matched with a child who had been physically, sexually, or emotionally abused?

Are you comfortable working with a child who has a physical health diagnosis? (i.e. allergies, asthma, diabetes, physical disability, etc.)

Are you comfortable working with a child receiving special education services for a developmental delay or learning disability?

Would you be willing to be matched with a child in the Foster Care System?

Are you comfortable working with a child who might have a different sexual orientation/preference (LGBTQ+)?

All of our Littles come from a variety of different backgrounds (social, emotional, mental, physical, economic, etc.). Please indicate your willingness to be matched with a youth who has experienced (or is experiencing) the following: *Please note that BBBS can provide additional coaching/training in any of these areas.

Comfortable with allAlcohol AddictionBullyingDrug AddictionPhysical AbuseSexual AbuseEmotional AbuseDomestic AbuseHomelessnessCommunity ViolenceParental IncarcerationDeath of a ParentNeglectNatural DisasterNone

BBBSNS Network

Do you know anyone involved in Big Brothers Big Sisters?

YesNo

What have they shared with you about the program?

Would you like to get involved with BBBSNS in other ways? (Check all that apply)

Event HelpFundraisingOffice HelpBoard / Committee MemberVolunteer at Re:Visions - (El Dorado County only)

Virtual Platform

Big Brothers Big Sisters of America has developed an internal 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 mutually agreed upon by all match participants.

Release of Information Authorization for Background Check

I consent to the preparation and release of background reports to Big Brothers Big Sisters of America and its' designated representatives (including, Big Brothers Big Sisters of Northern Sierra). I understand this is a necessary requirement in order to maintain the safety and well being of all the youth involved in BBBS Programs per National Standards.

Publication Release

Publicity and promotional materials for Big Brothers Big Sisters are conducted in a variety of forms. May we use your name, image, likeness, appearance, or basic biographical information in these materials?

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.

I have answered these questions honestly and completely to the best of my knowledge.

Pre-Interview Questionnaire

Occupational and Educational Information:

What subjects do you find most interesting?

Do you participate in any school clubs or extracurricular activities?

YesNo

Please state any and all sports/clubs/extracurricular activities:

Do you have any specific career/college goals?

Family Relationships:

Do you have any siblings?

YesNo

Where did you grow up?

What do your parents do for a living?

How would you describe your current relationships with your parents, siblings, and other family members?

Relationship History & Friendships:

How do you pass the time with friends? What do you enjoy doing together?

How long have you known your friends?

Leisure Time:

What do you enjoy doing in your free time? Please share some of your hobbies/interests/recreational pursuits:

Would you describe yourself as a person who enjoys:

Which do you enjoy more?

Are you currently taking any mood altering medication?

YesNo

Please Explain:

Are you undergoing any counseling?

YesNo

Are you experiencing any physical or mental health problems?

PhysicalMentalNone

Have you been hospitalized in the last 5 years for physical/mental health reasons?

Do you anticipate (or have you recently undergone) any major life changes?

YesNo

Please Explain:

Do you have a religious affiliation?

Do you speak any foreign languages?

Do you use the internet recreationally? What are your most visited websites and/or social media platforms?

What 3 adjectives best describe you?

Home Assessment:

How long have you lived in the community?

Is there any chance you could be moving out of the communiy?

YesNo

Please Explain:

Personal Goals:

Would you like to become involved with BBBS in other ways?

Fundraising HelpEvent HelpOffice HelpReVisions Store in Cameron Park

Volunteer Match Preferences:

Do you imagine yourself with a talkative "Little," or a child on the quieter side?

What are some of the activities you can envision yourself doing with your Little?

What kind of personality traits might present a challenge for you to work with?

What qualities do you admire most in youth?

Would you be willing to be matched with a child who has been abused (physically, emotionally, or sexually)?

Do you have transportation?

YesNoMy Parent/Guardian will be transporting me

Have you had any driving citations in the last 5 years?

YesNo

Please Explain:

What day(s) are you available during the week to meet with your Little?

SundayMondayTuesdayWednesdayThursdayFridaySaturday

Is there anything else you'd like to share about yourself that has not been covered in this application?

Application Authorization

I consent to and understand that:

The references and youth serving-organization I listed may be contacted by telephone, mail or e-mail;
The information I provided may be used to conduct a background check, to include a search of public domain records, adult criminal history check, military records, and other records where required by local, state or federal law for volunteers working with youth;
I am in no way obligated to perform any volunteer services;
Big Brothers Big Sisters of Northern Sierra 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, BBBBS is not required to disclose reasons for doing so;
Other BBBS agencies and youth organizations where I have worked/volunteered may be contacted as references;
As part of the enrollment process, I will be required provide additional personal information, including completion of an in-person interview;
The information I provide in the enrollment process will be kept confidential, unless disclosure is required by law and with exceptions noted below.
Incidents of child abuse or neglect, past or present, must be reported to proper authorities;
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);
It is my responsibility to update the agency if any of the information I proved on this application, in my interview, or any other information provided during the enrollment process changes (ie. address, phone number, auto-insurance, new criminal charges, etc.)
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 of Northern Sierra.

I certify that all information I have provided or will prove to Big Brothers Big Sisters of Northern Sierra, 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 of Northern Sierra. I understand that misrepresentations or omissions maybe cause for my immediate rejection as an application 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 convections related to any civil, domestic, or criminal occurrences. I understand that BBBS staff needs to be fully information to proved the best guidance or support possible.

If volunteer is under the age of 18 a signature of a parent/ guardian is required below.

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