VOLUNTEER APPLICATION

VOLUNTEER APPLICATION
1176 Robert T. Longway Blvd Flint, MI 48503 Phone: (810) 235-0617 Fax: (810) 235-0689
Name *

First Name Middle Name Last Name
Address *

Home Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email: *
example@example.com
Home Phone #:
Cell Phone#:
Date of Birth: *

Month Day Year
Date
Gender Identity: *
Race: *
Marital Status:
Employer:
Address

Address

Street Address Line 2

City State

Zip
Work Phone#:
Work Hours:
How Long Employed:
Occupation:
Highest Level of Education:
If a student, list high school or college:
Expected Graduation date:

Month Day Year
Date
Major:
Do you belong to a Fraternity or Sorority?

Yes No
If yes, which one?
Possession of a driver’s license is not a requirement to participate in any of our programs but is required if you will be transporting a youth in any vehicle you are operating. Copies of driver’s license and proof of auto insurance are required.
Do you have a driver's license? *

Yes No
If yes, please enter DL #
Expiration date:

Month Day Year
Date
Do you have auto insurance? *

Yes No
If yes, Company:
Policy #:
List people in household (Name, Relationship, Age):
List previous addresses (include State & Zip):
Years at address: (ex. 1999 2000)
Would you be interested in mentoring a child with a parent who has been incarcerated? (Amachi Program-volunteer must be age 18 or older)

Yes No
FOR VOLUNTEERS AGE 18 AND OLDER: Would you be willing to complete FBI Fingerprinting if necessary?

Yes No Under 18
If applicable, please list place of worship:
Have you applied to be, or have been, a Big Brother or Big Sister?

Yes No
Where:
When:
Referred by:

Self Another Big Staff/Board Monday's Chid Event
Referred by: *
Please type or print information requested for three references: 1) your current or past EMPLOYER (or TEACHER) who has known you for at least 1 year, if neither apply-a friend; 2) a COWORKER, friend or neighbor who has known you for at least 2 years; and 3) a SPOUSE (or CLOSE FAMILY MEMBER) or a second friend who has known you for at least 3 years. DAYTIME PHONE NUMBERS, PLEASE! If a High School student, adult references preferred.
1. Employer/Coworker Name (Supervisor/Co-Worker; Teacher/Counselor, if a student) *
Email: *
example@example.com
Day Phone #: *
Address

Address

Street Address Line 2

State

Zip
2. Friend or Neighbor: *
Day Phone #: *
Email: *
example@example.com
Address

Address

Street Address Line 2

State

Zip
3. Spouse (Spousal Equivalent)/Close family member/Friend: *
Day Phone #: *
Email: *
example@example.com
Address

Address

Street Address Line 2

State

Zip
List any other youth organizations you have worked for or been involved with as a volunteer (List dates, name of organization, contact person and phone number):
Have you ever been involved before with Big Brothers Big Sisters in a capacity other than being a Big?

Yes No
If yes, what capacity, where and when:
Have you or anyone in your household ever been substantiated for child abuse and/or neglect by the Department of Health and Human Services?

Yes No
If yes, explain:
I understand that: 1) The references I listed may be contacted by mail, telephone, or email; 2) I am in no way obligated to perform any volunteer services; 3) The information I provided may be used to conduct a background check, to include driving records check, criminal background check, and other records where required by local, state, or federal law for volunteers working with youth; 4) The BBBS agency is not obligated to match me with a youth; 5) Other BBBS agencies or youth organizations where I have worked or volunteered may be contacted as references; and, 6) As part of the enrollment processes, I will be asked to provide additional personal information prior to any recommendations for assignment. 7) I give my permission for Big Brothers Big Sisters of Flint and Genesee County and Big Brothers Big Sisters of America and their funders to utilize any photos, audio tapes, video images, or other images/recordings for promotional and other purposes.
Volunteer Signature *

Clear
Date

Month Day Year
Date
PARENT PERMISSION:

If a High School student, a parent/guardian must complete the following: As parent/guardian, I give permission for the above applicant to volunteer as a mentor to a child. I feel he/she is capable of maintaining the commitment to the program. I understand the above information provided may be substantiated by Big Brothers Big Sisters of Flint and Genesee County to include the volunteer’s employment record, physical and mental health, character references, records of law enforcement agencies or courts of law and give my permission to do so. I give my permission for Big Brothers Big Sisters of Flint and Genesee County and Big Brothers Big Sisters of America and their funders to utilize any photos, audio tapes, video images, or other images/recordings for promotional and other purposes.
Parent Signature

Clear
Date

Month Day Year
Date
Rev. 08/2020
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform