BBBS 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. 

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Basic Information




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File can be a screenshot, PDF, or picture
Contact Information

























Employer Information











Additional Information






References and Background Check

Previous Experience










Volunteer Experience











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
Spousal/Familial Reference







Professional Reference







Minimum 1 year
Personal Reference







Minimum 2 years
VOLUNTEER EXPECTATIONS:

I consent to and understand that:
  1. The references and youth-serving organization(s) I listed may be contacted by mail, telephone, email, or in person;
  2. 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;
  3. I am in no way obligated to perform any volunteer services;
  4. 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; 
  5. Other BBBS agencies and youth organizations where I have worked or volunteered may be contacted as references;
  6. As part of the enrollment processes, I will be required to provide additional personal information, including completion of an in-person interview;
  7. I understand that the information I provide in the enrollment process will be kept confidential, unless disclosure is required by law.  
  8. I understand that detailed accounts of child abuse or neglect, past or present, will be reported to proper authorities;
  9. 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);  
  10. 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.)
  11. I agree to complete questionnaires throughout my time in the program to evaluate and improve program services;
  12. I agree to timely communication and follow-up with all agency staff as required by the agency.

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.  





Agency Weapons Policy






Please provide the name, age, and relationship to you for any other adult residing in your home, if none type N/A.


Release of Information Authorization for Background Check

REFERENCE/BACKGROUND CHECK RELEASE:

Having made application to become a volunteer with Big Brothers Big Sisters of Fond du Lac County, Inc. and desiring that organization be informed as to my past record and character, I hereby authorize the agency to investigate my past record and to ascertain any and all information which may concern my record and/or character.  I hereby release my present and past employers, organizations previously connected with, and all persons whomsoever from any damage because of furnishing said information.  This release expires on termination of my involvement with said organization.


Confidentiality Policy

In order for Big Brothers/Big Sisters of Fond du Lac County to provide a responsible and professional service to clients, it is necessary for volunteers, clients, and parents or guardians of clients to be asked 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 the situations listed below, shares information about clients and volunteers only among the agency professional staff and match parties when necessary and appropriate.  The right to confidentiality applies not only to written records, but to video film, pictures or use of client or volunteer's name in agency publications.

 

All records are considered the property of the agency and not the agency workers or 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 must be assessed along with information gained from the clients or volunteers.  Clients and volunteers shall be provided, at the time of application, a copy of this statement on confidentiality along with the exceptions which define the limits of confidentiality.  Clients and volunteers shall sign a statement that he/she has read and understands the agency policy on confidentiality and agrees to program participation under the guidelines it sets forth.

 

Limits of Confidentiality

 

1.         Internally generated information, or information received from outside sources will be released to other individuals or organizations only upon presentation of an authorized "Consent to Release Information" form appropriately signed by the client or volunteer.

 

2.         Identifying information regarding clients or volunteers may be used in agency publications or promotional materials if the client or volunteer has given permission.

 

3.         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 use information only for the purpose(s) 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 be requested.

 

 

4.         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 approval action of the Board.  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.

 

5.         Information shall only be provided to law enforcement officials or the courts pursuant to a valid and enforceable subpoena.

 

6.         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.

 

7.         State laws mandated that suspected child abuse be reported to the appropriated authorities (FDL County Dept of Social Services).

 

8.         If a situation exists where a client or volunteer may be dangerous to him/herself or others, necessary steps may be taken to protect the appropriate volunteer.

 

9.         At the time a child or volunteer is considered as a match candidate, information is shared between the prospective match parties.  However, the identity of the prospective match mate shall not be revealed at this stage.  Names are shared with match mates only after the involved parties agree to the match.

 

Each match party shall have the right to refuse the proposed match based on the anonymous information provided.  The information to be shared may include:

 

                        A.  Volunteer - age, sex, race, religion, interests, hobbies, family situation, living situation, reasons for applying to the program and a summary of why the individual was chosen for the particular match.

 

           B.   Child - age, sex, religion, interests, hobbies, family situation, living situation, sexual preference, a summary of the clients needs assessment and expectations for match participation.

 

The client or volunteer shall have the right to review and approve the specific information before it is presented to the potential match mate.  The individual to whom the information is provided shall agree in writing not to share the information with any other person. 



Media Consent and Release

I irrevocably consent to any and all uses and displays of my name, image, likeness, appearance, basic biographical information, audio/video recordings, writings, artwork, and the like, in original form or in modified form, in whole or in part, in, on, or in connection with merchandise, advertising, publicity, marketing, fundraising, and the like, in printed or electronic media, of any type, throughout the world at any time by Big Brothers Big Sisters of America and [BBBSA affiliate] in their sole discretion, and by any of their affiliates, successors, partners, sponsors, donors, any entities or persons with whom they conduct any public relations, marketing, or fund raising of any type, and any other authorized third parties, without further consent from me, without any royalty, payment, or other compensation to me, and with the release and waiver of any claims, actions, damages, losses, costs, expenses and liability of any kind arising from any such use (the “Released Material”).

In consideration of the mutual promises made herein, and for other good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge, I hereby grant to BBBSA and its affiliates the right to use the Released Material as BBBSA and/or its affiliates may desire, in all media now existing or hereafter created and in all variations and forms including, but not limited to, internal or external publications or productions, informational or recruitment materials, marketing materials, fundraising materials, televised photography and/or recordings, advertisements, Public Service Announcements, and/or online and social media sites. The use of this information shall be at the sole discretion of BBBSA and/or its affiliates.

I further grant to BBBSA and its affiliates the absolute right to use the Released Material in whole or in part, alone or in conjunction with any other image, name, writings or reproduction, in color or otherwise, for art, advertising, business, trade, or any other lawful purpose whatsoever, in perpetuity throughout the world.

I understand and agree that all materials created by BBBSA and/or its affiliates that use the Released Materials are the property of and are owned by BBBSA, and that I cannot authorize their use by any other party.  I further understand that BBBSA may authorize their use by a third party. I hereby irrevocably transfer and assign to BBBSA my entire right, title and interest, if any, in and to the Released Materials and all copyrights in the Released Materials arising in any jurisdiction throughout the world, including the right to register and sue to enforce such copyrights against infringers.

I acknowledge and agree that I have no right to review or approve the Released Materials before they are used by BBBSA and/or its affiliates, and that BBBSA has no liability to me for any editing or alteration of the Released Materials or for any distortion or other effects resulting from BBBSA’s and/or its affiliates’ editing, alteration or use of the Released Materials.  BBBSA has no obligation to use the Released Materials or to exercise any rights given by this Consent and Release Form.

I hereby release BBBSA and its affiliates, employees, and agents, as well as any partner companies, from all claims, demands or liabilities and related financial costs that I may now or hereafter have arising in connection with BBBSA’s exercise of the rights hereby granted, and/or with the appearance or the Released Materials in any publication or production. These include, without limitation, claims for compensation, defamation, or invasion of privacy, or other infringements or violations of personal or property rights of any sort whatsoever.

Child Safety Guidelines and Ground Rules for Volunteers                                                                      

Only accepted Bigs in the Community-based program are allowed to transport children.  In rare instances of emergency when the Big is unable to transport, the parent should be contacted before someone other than the Big transports the child.

 

The Big and child must abide by all laws related to traffic, seat belt use, and transporting children.

 

The Big is not allowed to consume intoxicants prior to transporting the child.  The Big is not allowed to use a cell phone while transporting the child. 

 

When the match participates in an activity that costs money, the Big covers the cost.

 

No loan or gift of money from the parent, from the Big, or from the child is allowed.

 

Presents for the child are only allowed at holidays and birthdays and should be kept small. 

 

No visits to the volunteer’s home are allowed for at least the first three months and only after agreement of both the parent and BBBS agency staff.

 

No overnights may occur for at least a year and only after agreement of both the parent and BBBS agency staff. 

 

Weapons of any kind must be disclosed and kept locked, out of reach of the child.  Weapons of any kind are not allowed on Big Brothers Big Sisters premises or at Big Brothers Big Sisters activities. 

 

The Big must approve all activities with the parent/guardian.

 

The parent/guardian, the child, and the Big must return calls and/or e-mails from the BBBS staff and actively participate in the match support process. 

 

The child’s siblings and other family members or friends should not be included in match activities. 

 

The volunteer must provide supervision of the child at all times during the match. 


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.  

Contact Information