Program Volunteer Application Step 1 of 9 11% Program* Big Brother Big Sister Big Couple In-School Mentor Go Girls Mentor Game On Mentor Big G Mentor (55+) PRISM Mentor Full Name* First Last PRONOUNS Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code How long living at this address?* Previous address if less than 1 year: Occupation:* Place of employment:* Home phone:*Work phone:Cell phone:*Email address:* Age:* Date of birth:* Number of children and their ages?Marital status:* Single Married Common-law Divorced/Separated In a relationship Widowed How did you learn of Big Brothers Big Sisters?*Have you ever been, or applied to be a volunteer with a Big Brothers Big Sisters agency in the past? If so, where and when?* Do you know anyone active in our agency right now? If so, who?* How long have you considered getting involved? (week, month, year, etc)* Why do you want to become a volunteer in the program now?* Age preference for Mentee:* 6-10 11-13 14-16 no preference Are you anticipating any changes in your life in the next 12 months?* Yes No If yes, please explain:Do you have experience working or volunteering with children?* Yes No If yes, please provide examples with dates:Other volunteer experiences:*What kinds of activities do you enjoy?*Do you have access to a vehicle?*Please note that children under 12 must sit in the rear of all vehicles Yes No Driver’s license #:*(Please note: we will take a copy of your Driver’s License during your interview) Plate #:* Auto insurance information:*Have you ever been questioned/arrested/convicted for anything other than a traffic offense?* If yes, please specify:Have you ever been in trouble with the police?* Yes No If yes, please explain and provide dates: What level of education have you achieved?* High school Trade School College University Some University Name of Trade School, College or University attended:* Are you presently a student?* Yes No School: Mentor ReferencesPlease note that if email addresses are provided for your reference, they will receive an email with an attached fillable reference form. Please encourage your references to check their email, including the junk mail folder, for the reference form.Vulnerable sector ReferenceTo be provided if you have volunteered/worked with vulnerable persons (children under 18, elderly, or those with disabilities) in the past 5 years. If there have been no experiences, please provide employer reference below #2.Name: First Last Company name: Home Phone:Business Phone:Cell Phone:Email: Relationship: Length of relationship: Employer ReferencePlease provide current employer if no experience with a vulnerable population in past 5 years. Name: First Last Company name: Home Phone:Business Phone:Cell Phone:Email: Relationship: Length of relationship: Personal ReferenceA personal friend or someone other than a family member or former employer who has known you for 2+ years.Name:* First Last Home Phone:*Business Phone:Cell Phone:*Email: Relationship:* Length of relationship:* Partner ReferenceIf applicableName: First Last Home Phone:Business Phone:Cell Phone:Email: Relationship: Length of relationship: Family ReferenceAdult family member such as a parent, sibling, cousin, grandparent, aunt, uncleName:* First Last Home Phone:Business Phone:Cell Phone:*Email: Relationship:* Length of relationship:* Consent* I hereby make application to become a volunteer. Understanding the nature of the volunteer work involved, I give permission for those I have named to be approached for personal references and for the information I have given to be verified. I understand this information to be confidential and that it remains the property of the Big Brothers Big Sisters. I also understand that I will be subject to police clearance. I fully understand that the organization, following review of my application, reserves the right to accept or refuse my application.Name* First Last Date* MM slash DD slash YYYY Notice: It sometimes takes a moment for the form to go through. Please do not click submit more than once. Thank you! Facebook Twitter Google+ LinkedIn
