Workplace/Site-Based Volunteer Application

At a minimum, please complete required information. All other information can be submitted at Mentor Orientation.

First Name(Required)

Middle Name

Last Name(Required)

Other Names Used

Cell Phone(Required)

Home Phone

Work Phone

Preferred Contact Method

Phone

Text

Primary Email Address(Required)

Secondary Email Address

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Gender

Male

Female

Transgender: Male to Female

Transgender: Female to Male

Non-binary

Date of Birth

Social Security Number

Race

American Indian

Alaskan Native

Asian

Black/African American

Native Hawaiian/Pacific Islander

White/Caucasian

Some Other Race

Ethnicity

Hispanic/Latino

Not Hispanic/Latino

Marital Status

Single

Married

Divorced

Widowed

Separated

Has Significant Other

Has Domestic Partner

Living w/ Significant Other

Have you ever been involved with BBBS before?

Yes

If yes, how?

Former Big

Former Little

Former Parent

Highest Level of Education

Are you bilingual?

Yes

If so, what language?

Military Status

Branch of Service

Duty Station

Rank

Social Media Handles

Facebook

Instagram

TikTok

Employment Information

Employer Name(Required)

If employer is not listed, please select other and enter employer name below

Occupation

Employer's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

May we contact you at work?

Yes

Work Hours

Length of Employment

Background Information

Do you have a drivers license or state ID?

Driver's License

State ID

Neither

Driver's License/State ID Number

State Issued

Expiration Date

Do you have Auto Insurance?

Yes

Have you ever been arrested OR convicted?

Yes

Are you currently charged with a felony or misdemeanor, including deferred adjudication?

Yes

Have you ever been or are you currently being investigated for allegedly abusing, neglecting, or exploiting children, elderly or the disabled?

Yes

If you answered “yes” to any of the last three questions, please list details, including the degree, city, state, and county of the event.

Do you have any communicable diseases?

Yes

Please Explain

Do you anticipate any major life changes in the next 6 months, such as moving, marriage, job changes, or pregnancy?

Yes

Please Describe

References (for faster processing, provide information on 5 references):

1) Spouse/Domestic partner, family member, OR an adult living in your home (required if applicable):

First Last

Nature of Relationship

Daytime Phone Number

2) Youth Serving Reference- volunteered with youth in the last 5 years (required if applicable):

First Last

Nature of Relationship

Youth Serving Organization

Daytime Phone Number

3) Other Adult:

First Last

Nature of Relationship

Daytime Phone Number

4) Other Adult:

First Last

Nature of Relationship

Daytime Phone Number

5) Other Adult:

First Last

Nature of Relationship

Daytime Phone Number

Please click and sign below to authorize the following Releases/Permissions:

By typing your name in the box below you are signing this application electronically and agreeing to all the boxes checked above.(Required)

Date

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