3461 Robin Lane, Suite 2Cameron Park, CA 95682T 530 626 1222www.bbbs-edc.org

Volunteer Application

First Name:

Middle Name:Last Name:Date of Birth:

Home Address:

City:County:State:Zip:

Email:

Home Ph #:Work Ph #:Cell Ph #:

GenderSocial Security #:

Current/ Former (if retired) Employer:

Employers Address:

City:State:Zip:

Current/ Former (if retired) Occupation:

Ethnicity: Domestic Partnership Status: Highest Level of Education (yrs):

Can We Contact You At Work:

_____Yes _____NoWork Hours:How Long Employed:

Do you have a drivers license?

_____Yes _____NoIf yes, state of issue and #Expiration date:

Have you ever been convicted of a crime?

Yes_______ No _______If yes, please give date(s) of the conviction(s)?Please describe the nature of the offense(s):

Please list any states you have resided in other than California:

References: Please type or print information requested for three references (known longer than 1-year)

1. Supervisors Name/ Good friend (if self employed or teacher if a student):

Day Phone #:

Relationship w/ Reference:

Email:

2. Coworker, Friend or Neighbor:

Day Phone #:

Relationship w/ Reference:

Email:

3. Spouse/Domestic Partner/Friend:

Day Phone #:

Relationship w/ Reference:

Email:

Pre-Interview Questionnaire

Occupational and Educational Information:

1. Are you currently Working/attending School? _____Yes ______No2. What is your work/ school schedule? _____________________________________________3. What is your occupation or former occupation (if retired)? ___________________________4. What do/did you find most rewarding about your job? ______________________________5. What, if anything, would you like to change about your job? __________________________6. How long have/ were you in this field of work? ____________________________________7. Why did you leave your last job? ________________________________________________8. Where did you graduate from high school? ________________________________________9. Did you attend college? If so, where and what was your major? _______________________10. Do you have any further educational goals at this time in your life? ____________________11. Do you have any military experience? ____________ When did you serve (dates)?_____________ Currently active? _____________ Job positions held & job duties performed: ___________________________________________________________________________________________________________ Where have you been stationed? _____________ Have you ever been deployed?__________ Where & when?________ Currently deployable? ____________ IF applicable, why did you leave the service? ___________________________________________________________________________________________________________

Family Relationships:

1. Do you have any siblings? _____Yes _____No2. Where did you grow up? ______________________________________________________3. What did your parents do for a living? ____________________________________________4. How would you describe your current relationships with your parents, siblings, and other family members? _______________________________________________________________________________________________________________________________________

Relationship History & Friendships:

1. Are you currently married/domestic partnership or in a serious relationship? __Yes ___No2. How did you meet? _______________________________________________________3. How long have you known each other? ___________________

Leisure Time

1. What are some of your hobbies/ interests/ recreational groups? _________________________________________________________________________________________________2. Are you a member of any professional organizations (Bar Associations, Rotary, etc)? _________________________________________________________________________________

3. What is the time commitment for the above hobbies/ organizations/ etc? ______________4. Over the past 5 years, have there been any changes in how you spend your leisure time? __ Why do you think that is? ____________________________________________5. Would you describe yourself as a person who enjoys:_______Watching events/activities _______Participating in event/activities ______Both6. Which do you enjoy more?_______Indoor activities________Outdoor activities _________No preference 7. Do you now or have you ever used alcohol, drugs or tobacco? ________________________If so, how have they played a role in your leisure time? ____________________8. Do you have a history of substance abuse in your family? _____ Yes _____ No9. Have you ever had an alcohol or drug related accident/ incident? ____Yes _____NoIf yes, please explain: ______________________________________________________10. How often do you (and significant other, if applicable) currently consume alcohol? ________11. Are you currently taking any mood altering medication? _____________________________12. Are you undergoing any counseling? _____________________________________________13. Are you experiencing any physical or mental health problems? _____Yes _______No14. Have you been hospitalized in the last 5 years for physical/ mental health reasons? ________15. Do you have a religious affiliation? ______________________________________________16. How much of your free time is spent online? ___________ For what purpose? _______________________________________________________________________________________ 17. If we were to Google you, what would we find? ____________________________________ ___________________________________________________________________________18. Thinking about whats on your personal web pages, is there anything on there that would be inappropriate for a child to read/view? 19. Do you plan to interact with your Little online? _____________________________________

Home Assessment:

1. Who else lives with you? (What are their relationships to you?) ____________________2. On a scale of 1 to 10 (10 being very safe) how would you rate the safety of your neighborhood? ___________________________________________________________3. How long have you lived in the community? ___________________________________4. Is there any chance you could be moving out of the community? _____Yes _____No 5. Would a youth generally enjoy being around your home, why? ____________________________________________________________________________________________6. What are some of the things you can imagine doing with your Little at your home? ____________________________________________________________________________7. Would you be able to make inappropriate viewing materials in your home unavailable for a child? _______Yes ______No8. Do you have any firearms or ammunition at your house? ______Yes ______NoIf yes, what safety precautions are set up: ________________________________9. Do you have any pets? ________Yes _______No Child Friendly? ______Yes _______NoIf yes, what kind of pets: _____________________________________________Are they up to date on their vaccinations? ______Yes _______NoAre you able to put the animal way when the child is around? _______________10. Both in and around your home, what do you think are some of the safety considerations both you and youth will have to take into account? ______________________________

Experience with Children:

1. Do you have any experience with children (other than that of raising children)? _______________________________________________________________________________2. What were the ages of the youth you worked with? ______________________________3. For how long did you volunteer? How many hrs. per week, etc.? ____________________4. What did you learn? ________________________________________________________5. What qualities do you admire most in children? __________________________________ 6. What did you most enjoyed about working with children and any challenges you had? _____________________________________________________________________________

Personal Goals:

1. What attracted you to BBBS as a way of becoming involved in working with youth? ___________________________________________________________________________2. How did you hear about BBBS? _____________________________________________3. How does this volunteering opportunity fit with your personal goals? _______________________________________________________________________________________

Volunteer Match Preferences:

1. What is the youngest and oldest age you see yourself working best with? __________2. Do you imagine yourself with a talkative child, or someone more on the quiet side? ______________________________________________________________________3. Do you imagine yourself with a child who asks for your advice, or who prefers to work thing out on their own? ____________________________________________4. Do you imagine your Little to be very active? What are some of the activities you see yourself doing together? ___________________________________________________5. Would you be willing to be matched with a child coming from a home with a history of substance abuse? ____Yes _____No6. Would you be willing to be matched with a child who had been physically, emotionally, or sexually abused? ____Yes ____No7. Are you comfortable working with a child that has an incarcerated parent or loved one? ______Yes ______No8. Are you willing to work with a child with a mental health diagnosis (depression, PTSD, ADHD, etc.)? _____Yes ______No9. Are you comfortable working with a child with a physical health diagnosis (asthma, allergies, diabetes, etc)? ____Yes _____No10. Are you comfortable working with a child receiving special education services for a developmental delay or learning disability? ______Yes ______No11. Would you be willing to be matched with a child in the foster care system for our Foster Based Mentoring Program? ____Yes ____No12. Are you comfortable working with people with other religious beliefs than your own? _____Yes _______No13. Are you comfortable working with a Little or family members that may be of a different sexual orientation than your own? _______ Yes _______No14. How would you respond if your Little or their family asked about your sexual orientation or your opinion of the sexual orientation of others? _____________________________15. How far are you willing to drive? ____________________16. Is there anything else about yourself that we didnt get a chance to discuss and that youd like to share now? __________________________________________________________________________________________________________________________

Supplemental Questions

1. What are 3 adjectives to describe you? ____________________________________________________________________________________________________________2. Have you ever applied to be or been matched as a Big Brother or Big Sister with this or any other BBBS agency? _______Yes ________NoIf yes, when and where: _____________________________________________3. Have you ever been involved with Big Brothers Big Sisters in any other capacity other than as a Big? ______Yes ________NoIf yes, when and where: _____________________________________________4. What (if any) other youth organizations have you worked for or been involved with as a volunteer? ______________________________________________________________5. Do you know anyone involved in BBBS? ___________ What have they shared with you about the program? _______________________________________________________6. Would you like to become involved with BBBS in other ways:_______Event Help_______Fundraising Help_______Office Help

7. Do you have transportation? _______Yes ________No8. Do you anticipate (or had recent) any major life changes? _________Yes _________NoIf yes, please explain: _______________________________________________9. Do you speak in foreign languages? __________________________________________10. Have you had any driving citations in the past 5 years? ______Yes _______NoIf yes, please explain: _______________________________________________11. Do you have any questions? ________________________________________________________________________________________________________________________

I understand that:

1) The references I listed may be contacted by mail, telephone or email2) I am, in no way, obligated to perform any volunteer services3) 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 youth4) The BBBS agency is not obligated to match me with a youth5) Other BBBS agencies or youth organizations where I have worked or volunteered may be contacted as references 6) I will be required to attend a pre-match training as well as the required training sessions offered throughout the year

_________________________________________________________________Signature of Volunteer Date

Our Mission is to provide children facing adversity with strong and enduring, professionally supported one-to-one relationships that change their lives for the better, forever.Updated 2/2014 AH