Volunteer Application

Personal Information

Name: *

Date of Birth: *

SSN:

Address: *

City: *

State: *

Zip: *

Email: *

Phone: *

Employment/Education

Current Employer:

Job Title:

Work Phone Number:

May we call you at work?

Yes

No

Are you currently a student?

Yes

No

School:

School Address:

School City:

School State:

School Zip:

Additional Information

Have you ever lived outside of Pennsylvania in the last 10 years?

Yes

No

Do you anticipate a job change/move in the next year?

Yes

No

Do you have access to an automobile?

Yes

No

Do you have a valid driver's license?

Yes

No

Have you ever applied for a job at Family Services of NW PA?

Yes

No

Have you ever been involved with the Office of Children and Youth?

Yes

No

Have you ever been a Big Brother or Big Sister?

Yes

No

If so, where?

References

Big Brothers Big Sisters of Family Services of NW PA requires that three positive references be obtained from: Spouse/Spousal Equivalent, Professional/School, and Personal. A fourth reference is required from youth serving organization(s) if applicant has disclosed relevant volunteer or paid experience with youth within the last 5 years.

Reference #1: Spouse/Spousal Equivalent

Reference 1 Name: *

Reference 1 Address: *

Reference 1 City: *

Reference 1 State: *

Reference 1 Zip: *

Reference 1 Email: *

Reference 1 Phone: *

Reference #2: Professional/School

Reference 2 Name: *

Reference 2 Address: *

Reference 2 City: *

Reference 2 State: *

Reference 2 Zip: *

Reference 2 Email: *

Reference 2 Phone: *

Reference #3: Personal

Reference 3 Name: *

Reference 3 Address: *

Reference 3 City: *

Reference 3 State: *

Reference 3 Zip: *

Reference 3 Email: *

Reference 3 Phone: *

Reference #4: Youth-Serving Organization (only if applicable)

Reference 4 Name: *

Reference 4 Address: *

Reference 4 City: *

Reference 4 State: *

Reference 4 Zip: *

Reference 4 Email: *

Reference 4 Phone: *

Volunteer Preferences

In which area of town do you live? *

In which areas of town are you willing to travel to see your Little? *

GENDER: Do you have a preference as to the gender of a child? *

Yes

No

AGE: Which age group do you feel most comfortable being matched with? *

Ages 6-7

Ages 8-10

Ages 11-13

No Preference

ETHNICITY: Which race/ethnicity do you feel most comfortable being matched with? *

Caucasian

Hispanic

African American

No Preference

COMPREHENSION: Which comprehension level would you feel most comfortable working with? *

Above Average

Average

Below Average

No Preference

Other talents and hobbies you would like to share with the child:

Applicant's Statement

By signing this application, I agree to engage in the mentoring match for at least one year. I also agree to inform Big Brothers Big Sisters of Family Services of NW PA of any infractions of the law including motor vehicle violations. My signature also gives Big Brothers Big Sisters of Family Services of NW PA permission to complete a criminal background check, including: Child Line, State Police Clearance, and National Sex Offender Registry. My name will also be verified against the Judicial System of Pennsylvania Web Portal. I understand that all information about me will be confidential. I agree to comply with all policies and procedures of Big Brothers Big Sisters of Family Services of NW PA.

Applicant Signature *

Personal Information

Employment/Education

Additional Information

References

Volunteer Preferences

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