Adult Volunteer Application Form

Pre-Applicaiton Checklist

Have you lived in the Central and Southern Interior of BC for at least 6 months?(Required)

Yes

No

Have you ever had ANY involvement (even if not charged or convicted) with the Police that would be reflected on a Criminal Record Check (i.e., police report, charged, suspected, convicted, pardoned, etc.)?(Required)

Yes

No

If you answered yes to the above criminal record check question: Has it been a minimum of 2 full years since the completion of your entire sentencing (i.e., Court, judgement and probation)?(Required)

Note: If it has not been 2 years, you are not eligible for our Programs at this time. We require a minimum of 2 full years from completion of sentencing before any consideration of your application. If yes, please be aware that depending on your involvement with the police, you may still be ineligible. We take every criminal record seriously, but on a case-by-case basis.

Yes

No

The application process can take up to approximately 2 months to complete. Once accepted as a volunteer, being matched with a mentee can take several weeks, depending on your program of interest, location, and other preferences. Are you able to make a one year commitment from the time you are matched with your mentee?(Required)

Yes

No

Do you anticipate any change in your residence, education, employment, health, or domestic status in the next two years?(Required)

Yes

No

If yes, please explain:(Required)

Volunteering as a BBBSCSI In-School Mentor means that you will be spending 1 hour once a week for a minimum 1 year during school hours with your mentee. Do you feel you can easily manage this with your schedule and future plans?(Required)

Yes

No

In some areas, we have wait-pools of Mentors who may have been waiting a long time for a mentor. Are you willing to commute? If yes, what cities would you be willing to volunteer in?

E.g., Kelowna, West Kelowna, Vernon, ...

Please list your previous 3 years of employment and/or school involvement:(Required)

Provide the name of the company or institution, the length of your employment, and your reason for leaving.

Are you planning to apply to a new job, school, program, or travel in the next two years? If yes, please explain.

Why do you want to volunteer as a mentor to a child/youth?(Required)

Please explain in a few sentences.

Please list any experience you have working with or being around children/youth:(Required)

What qualities do you feel you have to offer a mentee?(Required)

Please list your leisure time interests and activities (e.g., clubs, sports, hobbies, special interests):(Required)

Emergency Contact Information

Please provide information for a close friend or family member we may contact in the event of an emergency.

Emergency Contact Name(Required)

Relationship to You(Required)

Phone Number(Required)

Format: (###) ###-####

Alternate Phone Number

Format: (###) ###-#### x#####

Volunteer Permission and Release Agreement

TO: [BIG BROTHERS BIG SISTERS OF CENTRAL AND SOUTHERN INTERIOR OF BC] (THE “AGENCY”)

The Agency and Big Brothers Big Sisters Canada (“BBBSC”) are separate entities and this Agreement is between me and the Agency.

1. By applying to volunteer with the Agency (“Volunteer Application”) and signing this Agreement, I acknowledge, understand and accept that:

I am a legal resident of Canada and have reached the age of majority in the province or territory in which I reside. I acknowledge and agree that if I have not reached the age of majority of the province or territory in which I reside, my parent or legal guardian will also need to sign this Agreement in order for my Volunteer Application to be considered;
There is no obligation on the Agency to accept my Volunteer Application or assign me as a volunteer into a mentoring program (a “Mentoring Program”) and the Agency may terminate my involvement in a Mentoring Program in its sole discretion and without reason;
If I am accepted as a volunteer, my involvement in a Mentoring Program is not intended to create and shall not be construed as creating either an employee–employer relationship or a contract for services that would allow me to receive a salary, compensation, payment or any benefits, monetary or otherwise; and
If I am accepted into a Mentoring Program, I understand that I will be required to enter into a confidentiality agreement with the Agency, and I agree to abide by the volunteer position description(s) and code(s) of conduct established by the Agency, including any applicable guidelines, Standards and policies.

2. Assumption of Risk, Release and Reimbursement: I acknowledge, understand and accept that:

I am responsible for all risks associated with my involvement in a Mentoring Program including, without limitation, the risk of bodily or psychological harm or injury.
Subject to local laws, I agree not to sue the Agency, BBBSC and/or any of their member agencies in respect of any such injury or claim resulting from my participation in a Mentoring Program, my Volunteer Application, the acceptance or denial of my Volunteer Application, the Alumni Program and/or my association with the Agency or BBBSC.
I understand that I am fully responsible for any damage to my personal vehicle and/or property during my volunteer involvement in a Mentoring Program and that neither BBBSC nor the Agency insures personal vehicles or property belonging to its volunteers;
I agree to reimburse the Agency and/or BBBSC and/or any of their member agencies for any damages or losses of any kind (including but not limited to the injury of any other person and/or damage to or loss of property) that may arise in connection with my gross negligence, willful misconduct, or failure to act in accordance with published BBSC policies and guidelines and relating to or arising in connection with my participation in a Mentoring Program or my association with the Agency or BBBSC, including payment of any and all legal expenses of the Agency, BBBSC and/or any of their member agencies.

3. Background Check. I understand that my acceptance into the Mentoring Program will be conditional on my successful completion of a background check, which may include contacting the references included in my Volunteer Application and/or a criminal record check, for the purposes of confirming my suitability for the Mentoring Program. I agree to provide all necessary consents for such background checks.

4. Privacy Notice. The personal information provided by me or otherwise collected by the Agency in connection with my application will be used by the Agency for the purpose of evaluating and considering my Volunteer Application and if accepted into a Mentoring Program, for the purpose of administering the Mentoring Program. This information may include my name, phone number, mailing address, date of birth, results of background check, and driver’s license and auto insurance information. My personal information will be maintained by the Agency on a confidential basis and will only be disclosed to the parent(s) and/or guardian(s) of a child with whom the Agency may consider “matching” me in a Mentoring Program, to representatives of a school or institution in connection with my participation in a site-based Mentoring Program, to the BBBSC as required for the purposes of accreditation reviews or legal proceedings and as otherwise required or permitted by law. In the event the Agency ceases operations, any and all information about me held by the Agency will be provided to BBBSC, another BBBSC agency selected by BBBSC, or both and will be used for the purposes set out above.

In the event where it is deemed necessary, any and all information about me held by the agency will be provided to BBBSC, another BBBSC agency selected by BBBSC, or both and will be used for the purposes set out above. No information will be provided to persons or organizations outside of Big Brothers Big Sisters of Canada, and its agencies, about parents, children or volunteers without their express prior written consent except where required by law.

5. Other Terms of this Agreement.

In entering into this Agreement, I am not relying on any oral or written representations other than as set forth in this Agreement.
This Agreement shall be governed by and construed pursuant to the laws of the Province or Territory in which the Agency is located.
In the event that any provision or term of this Agreement is held to be invalid, illegal or unenforceable, the remaining provisions of this Agreement shall remain in full force and effect.

Applicant's Digital Consent Signature

First Last

Date

MM

DD

YYYY

Reference Information

Please provide FULL contact information for each reference and we will contact them as needed. Please contact your references to let them know we will be in touch with them and encourage them to respond in a timely manner. If any of your references are likely to experience barriers (language, etc.) in completing the reference form, please contact the agency for assistance. References must have known you for at least 2 full years and must be at least 19 years old. Otherwise, the reference will not be valid.

1. Personal Reference

A personal reference refers to anyone other than a family member who knows you well and on a personal level. They could be a work colleague or a close friend.

Personal Reference's Full Name(Required)

Relationship to You(Required)

Length of Relationship (in Years and Months)(Required)

Address(Required)

Street Address Address Line 2 City Province Postal Code

Home/Cell Phone Number(Required)

Format: (###) ###-####

Email Address(Required)

E.g., email@domain.com

Preferred Contact Method(Required)

Email

Phone

2. Employment Reference

If you do not have an employer reference that has known you for 2 or more years or are self-employed, you may use a volunteer supervisor, co-worker, client, or business partner that has known you for 2 or more years.

Employer (Company Name)(Required)

Years Employed(Required)

Supervisor's Full Name(Required)

Length of Relationship (in Years and Months)(Required)

Business Address(Required)

Street Address Address Line 2 City Province Postal Code

Supervisor's Home/Cell Phone Number(Required)

Format: (###) ###-####

Supervisor's Work Phone Number(Required)

Format: (###) ###-#### x#####

Supervisor's Email Address(Required)

E.g., email@domain.com

Preferred Contact Method(Required)

Email

Phone

3. Family/Significant Other Reference

Please provide contact information for your Significant Other (girlfriend, boyfriend, spouse or common law partner) if applicable.

Family Member's/Significant Other's Full Name(Required)

Relationship to You(Required)

Length of Relationship (in Years and Months)(Required)

Address(Required)

Street Address Address Line 2 City Province Postal Code

Home/Cell Phone Number(Required)

Format: (###) ###-####

Email Address(Required)

E.g., email@domain.com

Preferred Contact Method(Required)

Email

Phone

Have you worked with a youth serving organization before?(Required)

Work (paid or volunteer) which involved children/youth (e.g., teacher, coach, babysitter, Boys & Girls Club, Scouts etc.) If none, please put "N/A".

Yes

N/A

4. Experience with Children/Youth

Please provide a contact, even if you have known them for less than 2 years.

Was this a volunteer experience?

Yes

No

Organization/Company Name

Years Employed

Supervisor's Full Name

Length of Relationship (in Years and Months)

Business Address

Street Address Address Line 2 City Province Postal Code

Supervisor's Home/Cell Phone Number

Format: (###) ###-####

Supervisor's Work Phone Number

Format: (###) ###-#### x#####

Supervisor's Email Address

E.g., email@domain.com

Preferred Contact Method

Email

Phone

Have you previously applied to be or been a volunteer with a Big Brothers Big Sisters agency?(Required)

Yes

No

Other BBBS Agency Information

Big Brothers Big Sisters Location(Required)

Contact Person

When were you involved with this BBBS agency?(Required)

Confidentiality Policy

All staff and volunteers of BBBSCSI are required to abide by this Confidentiality Policy. Any breach of this policy will be considered grounds for termination.

Agency Service Delivery Staff will explain the confidential nature of our service to the volunteer, child and parent/guardian as early as possible in the orientation and/or screening process. At all times thereafter Service Delivery Staff will ensure the privacy of case information.

Information contained in the Casework files will not be disclosed by the Agency to any person without the written approval of said person except in the following cases:

where the safety of a child depends upon divulging this information. This could include suspicion of neglect or abuse of a child. The proper authorities will be informed when necessary. This could result in the disclosure of confidential information without written consent from the person to Big Brothers Big Sisters of Canada’s insurers and or legal counsel, as may be appropriate in connection with any legal proceeding or inquiry;

when subpoenaed by the courts;

where required by law;

during periodic agency accreditation reviews case records, including relevant personal information will be shared to authorized representatives of Big Brothers Big Sisters of Canada.

In the event that confidential information is requested to support a custody or access application, or for any court matter other than a “child protection” case, the agency will only release the information if required to do so by a Judge’s Order.

No staff member or volunteer shall use confidential information from the agency to advance any personal interest, financial or otherwise.

In accordance with Big Brothers Big Sisters of Canada’s National Standards:

No information will be provided to persons or organizations outside of Big Brothers Big Sisters of Canada, and its agents, about parents, children or volunteers without their express prior written consent except where required by law.

All information and records, including electronic records, shall be kept secure (for example, in a filing cabinet, desk, etc. under lock and key, password protected, etc.) and confidential at all times.

Case records will be accessible only to the Caseworker, Executive Director, Casework Supervisor, and in appropriate situations, other Caseworkers.

Applicant's Digital Consent Signature

First Last

Date

MM

DD

YYYY

Thank you!

Only those applicants that meet our requirements will be contacted for an interview. Please accept our appreciations for your interest!

Pre-Applicaiton Checklist

Volunteer Information

Contact Information

Other Information

Emergency Contact Information

Volunteer Permission and Release Agreement

Reference Information

1. Personal Reference

2. Employment Reference

3. Family/Significant Other Reference

4. Experience with Children/Youth

Other BBBS Agency Information

Confidentiality Policy

Thank you!