Volunteer with BN2N

BARNSTABLE BN2N
BN2N Use Only (08/2024) Rec'dHV

Neighbor 2 Neighbor Serving All 7 Villages

Orientation Vol. Agrmt Photo Release
Activation
Name
Home Address
Email
example@example.com
Home Phone
Cell
Preferred Method of Contact:

Home PhoneCell Phone
Gender:

MF
Birth Month
Birth Date
Birth Year
Emergency Contact
Name
Phone
Relationship
How long have you lived in Massachusetts
Services you are interested in providing to our members (check all that apply)

Drive (to appointments, errands, grocery store)Household and Yard Tasks (small repairs, light yard work)Technical Support (Android devices, apps)Technical Support (Apple devices, apps)General Technology Support (TV remotes, printers)
Organization support activities (check all that apply):

Administration (general administrative, support)Membership CommitteePublicity and OutreachService Coordinator (staff phone, receive and input member requests)Technical Support (Google administration and applications, Mailchimp, Adobe)Volunteer Committee
How did you hear about BN2N

0/200
Why are you interested in becoming a BN2N Volunteer?

0/200
What are your interests, hobbies, skills, strengths or professional experience that may be relevant to volunteering with BN2N?

0/200
Are you Bilingual
Languages Spoken
Signature

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Date
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Required Background Information

CORI Background Check: All applicants must pass a CORI (Criminal Offender Record Information) background check to become active volunteers and provide services and transportation to our members. Please complete and sign the attached CORI Acknowledgment Form. Your signed Form grants BN2N permission to conduct the background check.

To complete the CORI process, you must bring one government-issued identification (driver's license is preferred) to the orientation session to verify your identity.

Drivers: If you are planning to provide transportation, you will need to bring printed copies of your driver's license and the front page of your automobile insurance policy with coverage information to the new volunteer orientation session.

All completed BN2N forms are stored in a secure location. Results are shared with only select board members on a need to know basis.

Please complete the attached CORI Form
Criminal Offender Record Information (CORI)

Acknowledgement Form

Barnstable Neighbor 2 Neighbor (BN2N) is registered under the provisions of M.G.L. c.6,. & 172 to receive CORI for the purpose of screening current and prospective volunteers. BN2N submits CORI check requests directly to the Massachusetts Department of Criminal Justice Information Services (DCJIS).

As a prospective or current volunteer, I understand that a CORI check will be submitted with my personal information to the DCJIS. I hereby acknowledge and provide permission to BN2N to submit this information to complete the CORI. This authorization is valid for one year from the date of my signature. I also understand that BN2N may conduct subsequent CORI checks within one year of the date this form was signed by me. I may withdraw this authorization at any time by providing BN2N with written notice of my intent to withdraw consent to a CORI check.
First Name
Middle Initial
Last Name
Birth Month
Birth Date
Birth Year
Last SIX digits of Social Security Number
Street Address
Apt
City
State
2 Characters, ex: MA
Zip
By signing below, I provide my consent to the CORI check and affirm that the information provided above is true and accurate.
Signature

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Date
CORI Identity Verification at Volunteer Orientation

Government issued identification presented by volunteer:
Printed Name of BN2N Verifying Representative
Date

MonthDayYear
Date
Signature of BN2N Verifying Representative

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BARNSTABLE BN2N

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