Volunteer Enrollment Application - Big Brothers Big Sisters of the Capital Region

Volunteer Application

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.

Basic Information

Contact ID 18 Character

Enrollment ID 18 Character

Contact Owner ID

Contact Owner Email

First Name

Middle Name

Last Name

Maiden/Alias

input NA if none

Preferred Name

Birthdate

Social Security Number

Gender

How do you identify?

Personal Pronouns

What pronouns do you use?

Race/Ethnicity

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

Tribal & Regional Corporation Affiliations

Nationality

To select multiple, hold CTRL/CMD and click.

Relationship Status

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

Are you listed as an insured driver?

YesNo

Residence History

Please list all of the different cities and states you have lived in within the last ten years.

City/State

From

Contact Information

Personal Email

Work Email

Preferred Email

Mobile Phone

Cell Phone Provider:

Is it okay to text you?

YesNo

Work Phone

Work Phone Extension

Home 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 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.), relationship to you, and birth date of ALL adults 18 year or older living in your home:

Name

Birth Date

Relationship

Employer Information

Employment Status

Name of Employer

Occupation

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

Additional Information

Level of Education

Year Degree Obtained

Education Years Completed

Area of Study

Are you a Student at this time?

YesNo

Have you served in the military?

Branch of Service

Dates of Service

Are you separated/ discharged (other than retired)?

YesNo

If retired,separated, or discharged, please check the character of separation/discharge:

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

Which activities do you enjoy more?

Do you speak any languages other than English?

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

How did you hear about Big Brothers Big Sisters?

Referral Detail ID

Previous Experience

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

When?

Where?

Have you even been involved with or volunteered for another youth organization?

YesNo

When and where?

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

YesNo

When and where?

Are you interested in learning about additional ways to contribute to the Big Brothers Big Sisters Mission?

YesNo

Pease check all the interests that apply.

Becoming a donor
Helping to recruit volunteers
Volunteering at agency events for matches, Littles, waiting-list children, etc.
Volunteering at agency fundraising eventsInviting BBBS to speak at a company, church, organization, or other group of which I am a member

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.

Spousal/Familial 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

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.
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 will also be used to conduct an annual criminal background and driving records check for as long as I am matched. Continued involvement will be based on the information discovered. BBBSCR will rerun my background check every 3 years, as long as I am associated with the program.
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 do herby release the organization and its employees, agents, members, volunteers, and all other persons on its behalf from any and all liability for any damage or injury which I might sustain while participating in said program and activities. Including, but not limited to, any liability to any right of action that may occur. I understand that this information may be shared with partnership agencies when applicable.

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.

Background Check

You will receive a separate email from eSign Genie with the consent form for your Background Check.

Confidentiality Policy

https://docs.google.com/document/d/1EIaztjvXn2DNzX-9YDO6mWqC6lb5ON0bSVxyn2Wg0yw/edit

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.

I consent to use images and consent to use my name in promotional materials for Big Brothers Big Sisters of America.I do not consent

Social Media Guidelines for Volunteers

https://docs.google.com/document/d/1cZ9ureLp3SkJKlI07UxV3G9vxmqbZrR7SwpSplKD2jU/edit

Please indicate below which social media sites you participate in. Please check all that apply:

FacebookTwitterInstagramTumblrPinterestSnapchat

Other

I have read and understand the social media guidelines set by Big Brothers Big Sisters of the Capital Region. By checking this box, I am pledging to abide by these guidelines when using social media.

Child Safety Guidelines and Ground Rules for Volunteers

https://docs.google.com/document/d/1TWnQTR85r4Zl7MXvAa2tXXPju2tNk1m_GpESP6E-Cyw/edit

I have read the above requirements, which define my responsibilities as a volunteer with Big Brothers Big Sisters. I agree to abide by them as long as I am in the program.

Firearms and Weapons Guidelines and Attestation

I agree to keep any weapons and ammunition locked and inaccessible to the child assigned to me by BBBS while he/she is in my custody.

Are there firearms present in your home?

Gift Giving, Donations, and Work for Pay Policy

https://docs.google.com/document/d/1h_YbkWBlUlU-tPJbqtKE4oJdS1x8P1JlRhD6OlkQE50/edit

I agree to abide by the policies listed in the above document.

Volunteer Pre-Interview 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 that you will have an opportunity to discuss these questions and your responses more thoroughly during your in-person interview.

1. Do you have any concerns about your ability to fulfill the 12-month commitment required of mentors?

YesNo

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

YesNo

Please Describe

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

YesNo

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

YesNo

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

YesNo

6. Are you experiencing any physical or mental health issues?

YesNo

7. Do you speak any foreign languages?

YesNo

8. Is there anything else you’d like to tell us about yourself of any questions that you have?

YesNo

9. If you have lived in a country other than the US in the past 10 years, please provide a complete address and timeline.

10. Are you fully vaccinated?

YesNo

11. Have you received a booster shot?

YesNo

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

Contact Information

Volunteer Application

References and Background Check

Background CheckYou will receive a separate email from eSign Genie with the consent form for your Background Check.

Confidentiality Policy

Child Safety Guidelines and Ground Rules for Volunteers

Firearms and Weapons Guidelines and Attestation

Gift Giving, Donations, and Work for Pay Policy

Volunteer Pre-Interview Questionnaire

Background Check

You will receive a separate email from eSign Genie with the consent form for your Background Check.