2. The information I provide may be used to conduct a background check, to include a search of public domain records, driving record check, juvenile and adult criminal history check, military records and other records where required by local, state and federal law for volunteers working with youth.

     3. The references and youth-serving organization(s) I listed may be contacted by mail, telephone, email or in person.

     4. Other Big Brothers Big Sisters agencies and youth-serving organizations where I have worked or volunteered at may be contacted as references.

     5. The information I provide during the enrollment process will be kept confidential, unless disclosure is required by law and with the exceptions noted below.

     6. Incidents of child abuse or neglect, past or present, must be reported to the proper authorities immediately.

     7. 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/guardian and child preferences and any information relevant to a child’s safety or well-being, but will not include any counseling/therapy information Big Brothers Big Sisters receives).

     8. It is my responsibility to update the agency if any of the information I provide on this application, during my interview or any other information provided throughout the enrollment process changes (address, phone number, auto insurance, new criminal charges, etc.).

     9. I agree to timely communicate and follow-up with all agency staff.

     10. I am in no way obligated to perform any volunteer services.

I hereby authorize and instruct BBBS to procure a report on me, including a criminal background history, which I understand may include, among other information, arrest, conviction, and driving record information. I also authorize and instruct BBBS to verify my Social Security number and to investigate my background and character in any manner they see fit to evaluate my potential as a Big Brother or Big Sister, including obtaining information from medical providers, employers, educational institutions, military agencies, and any other sources. If I become a volunteer for BBBS, I authorize BBBS to repeat these investigations at any time for as long as I remain a volunteer. I authorize BBBS to disclose relevant information obtained from its investigations to the parent/legal guardian of any child considered as a possible Little Brother or Little Sister to effectively enable the parent to exercise “parental choice” in accepting or denying me as a Big Brother or Big Sister for their child. I authorize and instruct any individual, corporation, and public or private entity having knowledge about me to furnish to BBBS any and all information they may have regarding me. I unconditionally release and hold harmless BBBS and its officers, directors, employees, and agents and any party furnishing information to them pursuant to this authorization from any liability, claims, charges, costs, or causes of action which I or my heirs, executors, or assigns may have as a result of the delivery, disclosure, non-disclosure, or omission of any information. I additionally agree to indemnify BBBS and its officers, directors, employees, and agents for any and all attorney fees, court costs, and other expenses resulting from investigating my background, gathering information concerning me, or verifying personal information about upon the written request of law enforcement agencies. BBBS uses technology tools to enhance personal relationships. Our online platform allows volunteers, youth, parents and BBBS to connect securely using a web application. Furthermore, I understand that BBBS holds the right to deny my participation in the program and, for confidentiality, is not required to disclose reasons for doing so. All parties agree that electronic/digital signatures are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility. A photocopy of this authorization may be accepted in lieu of the original.

As a volunteer for Big Brothers Big Sisters of the Midlands (BBBSM), I am provided excess (secondary) automobile liability insurance coverage when using my vehicle for activities related to my volunteer service to BBBSM.  In order to qualify for this excess (secondary) insurance, I must carry primary insurance that meets the state of Nebraska minimum requirements for automobile insurance.  My failure to carry the minimum coverage will preclude me from being able to qualify for the excess insurance should I need it.

In order to be compliant with Nebraska’s car insurance laws, you must have liability insurance.  This helps cover costs towards injury and property damage suffered by others in a car accident you cause.

In Nebraska, your car insurance policy must meet at least these following liability coverage minimums per accident:

·         $25,000 for bodily injury, per person.

·         $50,000 for total bodily injury if multiple people are hurt.

·         $25,000 for property damage.

In Iowa, you can choose whether or not to buy car insurance; however, if you get into an accident or you lose your driving privileges, you must be able to show proof of financial responsibility right away.  The easiest way to fulfill this requirement is to purchase an Iowa car insurance policy.

Iowa has specific requirements for car insurance that must be in place on all vehicles to be legally driven in the state. The following coverages and limits are the minimum levels acceptable by the state of Iowa:

·         Bodily Injury Liability Coverage: $20,000 minimum per person, $40,000 minimum per accident

·         Property Damage Liability Coverage: $15,000 minimum

·         Uninsured Motorist Bodily Injury Coverage: $20,000 minimum per person, $40,000 minimum per accident

·         Underinsured Motorist Bodily Injury Coverage: $20,000 minimum per person, $40,000 minimum per accident

I understand this is an application for a volunteer opportunity and is not a promise or commitment by Big Brothers Big Sisters of the Midlands. All applications will be given equal consideration regardless of race, age, sex, gender identity or expression, disability, marital status, sexual orientation, religion or national origin.

I certify that all of the information I have provided or will provide to Big Brothers Big Sisters of the Midlands, 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 information contained on my application will be verified by Big Brothers Big Sisters of the Midlands. I understand misrepresentation 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 of the Midlands program, I agree to immediately inform my Big Brothers Big Sisters of the Midlands contact person of any and all infractions, violations, charges and convictions related to any civil, domestic or criminal occurrences. I understand that Big Brothers Big Sisters of the Midlands staff needs to be fully informed to provide the best guidance or support possible.