BBBS Volunteer Application

Mission: create and support one-to-one mentoring relationships that ignite the power and promise of youth.

Non-Discrimination Policy

Our participants come to us with a wide range of personal characteristics and we value our differences. Participant eligibility shall be determined without regard to race, ethnicity, color, religion, national origin, gender, marital status, sexual orientation, gender identity, veteran status, or (dis)ability.

Application

This application will take 20-30 minutes to complete. Depending on the program type, you will need the following items to complete the application:

Picture/digital copy of your driver's license or photo ID
Picture/digital copy of your driver's insurance
Phone number and email address of references: personal, spouse/familial, employer, and any youth-serving organizations you have volunteered or worked with in the last 5 years.
Phone number and date of birth of any adults in the home.

Which program(s) are you interested in applying for? If you have not attended an orientation, you will learn more about programs then. You can change your program interest at any time.

Community-based (outings into the community; 2-4 times a month)Site-based (meeting at a school or site with BBBS staff present to support; weekly during the school year)Career Mentoring Exploration (workplace mentoring with high school students; monthly during the school year)*only available if your workplace is participating*I am not sure or I am interested in all.

Workplace and industry:

Contact Information

Personal Email

If you don't have an email, enter swwabigs.program@gmail.com

Alternate or Work Email

Preferred Email

Cell Phone

If no cell phone, enter home number.

Work Phone

Work Phone Extension

Home Phone

Alternate Phone

Preferred Phone

Best Time to Call

In general, how do you prefer to be contacted?

Mailing Address

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

Mailing County

Other Mailing County

Mailing address is different from physical address.

Physical Address

Street Address

City

State

Zip Code

Emergency Contact Information

Name

Phone

Relationship

Employer Information

Employment Status

Employer/School

Occupation (if student, select "student")

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 with BBBS

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

When?

Where?

Were you matched in the program you applied for?

YesNo

How long were you matched?

References

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.

Spousal/Family Reference

Spousal/Familial Reference ID

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Professional 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

Volunteer Experience

Organization Name

Location

Start Date

End Date

Direct Supervisor First Name

Direct Supervisor Last Name

Phone

Email

Years Known

Reason for Leaving

Volunteer Experience

Organization Name

Location

Start Date

End Date

Direct Supervisor First Name

Direct Supervisor Last Name

Phone

Email

Years Known

Reason for Leaving

Enrollment Questionnaire

Prior to your in-person interview, please answer the questions below. Parents of youth in our programs will often ask questions about someone with whom their child will be matched. 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: you will have an opportunity to discuss these questions and your responses more thoroughly during your in-person interview.

Enrollment Questionnaire

What interests you in being a part of the Big Brothers Big Sisters program?

What do you have to share with a mentee (skills, talents, interests, experience)?

What are some of your interests and hobbies?

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

Please describe your concerns regarding the commitment:

Do you anticipate any significant life changes over the next year or had any this past year?

Please describe the changes:

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

Please describe:

Have you had any driving citations and/or moving violations in the past 5 years?

Please describe:

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

Are they secured in a gun safe, locked cabinet or gun lock?

Yes. No, but they could be if needed.No.

Please describe:

Have you, or are you currently, experiencing physical or mental health issues?

Please describe:

Do you have any pets?

YesNo

What types of pets do you have?

Do other adults live in the household with you?

YesNo

Adults In the Home

To ensure safety, our process includes a basic screening of other adults living in a volunteer's home, including a reference call. 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:

Their Name:

Their relationship to you:

Their Date of Birth:

Their phone number:

Their email address:

Do children (under 18 yrs old) live in the home with you?

YesNo

Please tell us who the children are in relation to you ( ie step-children, grandchildren, etc):

Is there anything else you would like to tell us about yourself or any other questions you have?

Consent and Releases

Confidentiality Policy

In order for Big Brothers Big Sisters of Southwest Washington to provide a responsible and professional service to clients, it is necessary for volunteers, clients, parents or guardians 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 situations listed below, shares information about clients and volunteers only among the agency’s professional staff. The right to confidentiality applies not only to written records but to video, film, photographs, or use of volunteer or client’s name in agency publications. All records are considered the property of the agency and not the agency workers, 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, shall be assessed along with information gained from the clients or volunteers. Clients and volunteers shall be provided, at the interview, with a copy of this statement on confidentiality along with a list of the expectations, which define the limits of confidentiality. Clients and volunteers shall sign a statement that they have read and understands the agency policy on confidentiality and agrees to the program participation under guidelines it has set forth.

Limits of Confidentiality

Information may be released to other individuals or organizations only upon the written consent by the client or volunteer.
Identifying information regarding clients and volunteers may be used in agency publications and/or promotional materials if the client or volunteer has given permission.
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 may have 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 purpose 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.
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 review and the period of time during which access shall be granted. Members shall be required to comply with the agency policies on confidentiality and may 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.
Information shall only be provided to law enforcement officials or the courts pursuant to a valid and enforceable subpoena or as required by statute, with exception to number 8 and 9 (see below).
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.
State law mandates that suspected child abuse shall be reported to the appropriate authorities (Child Protective Service). All workers are responsible for staying abreast of such reporting requirements of the irrespective jurisdiction and shall always comply with mandated procedures.
If an agency worker receives information indicating that a client or volunteer may be dangerous to themselves or 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 or a mental health professional, as appropriate.
It is the position of the agency to not “out” a young person in regards to their gender identity, gender expression or sexual orientation that is confidential to the youth or the parent/guardian. The information will be kept confidential with those whom the child chooses to tell.

Agreement to Protect the Confidentiality of Match Information

I agree to keep the information discussed with me regarding a potential (Big or Little) match confidential. I will not discuss this information with any person other than Big Brothers Big Sisters of Southwest Washington professional staff. I have read and understand that 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 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 Release

Publicity and promotional materials for Big Brothers Big Sisters are conducted in a variety of forms. By selecting below I authorize Big Brothers Big Sisters to identify me in the media as a Big Brother or Big Sister using my full name. I also give permission for the use of other forms of media including but not limited to written word, photo, video, social media, and voice recording.

Yes, I agree to have my media used for BBBS. No, I do not want my media used for BBBS.

Consent to References and Background Checks

I consent to and understand that:

The references and youth serving-organization 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 and with exceptions noted below.
I understand that incidents of child abuse or neglect, past or present, must 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 timely communication and follow-up with all agency staff.
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.

I consent to the preparation and release of background reports to Big Brothers Big Sisters of America and its designated representatives.

American Indian or Alaska Native	Asian Indian
Black or African American	Chamorro
Chinese	Filipino
Cuban	Mexican, Mexican American, Chicano
Japanese	Korean
Middle Eastern or North African	Native Hawaiian
Other	Other Asian
Other Latinx or Spanish Origin	Other Pacific Islander
Puerto Rican	Samoan
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