Volunteer with Big Brothers Header

Volunteer Application
Questions marked by * are required.
1.
First Name: *
2.
Middle Name:
3.
Last Name: *
4.
Sex: *
  • Male
  • Female
5.
Address: *
6.
City: *
7.
Zip Code: *
8.
Primary Phone: *
9.
Secondary Phone:
10.
Best Time to Call:
11.
Email Address: *
12.
Ethnicity: *
13.
Birthdate: *
14.
Birthplace: *
15.
Please select program(s) of interest: *
  • One-to-One Match Program (1 yr+, 1 day a week, a couple of hours)
  • After-School Program (6 mo+, Tues or Wed, 2:30-5:30pm, Watsonville)
16.
How did you hear about the agency? (OR How were you most recently reminded?): *
  • GoodTimes advertisement
  • Newspaper article/ad
  • TV commercial / Movie
  • 1-800-Volunteer.org
  • VolunteerMatch.org
  • Volunteer Center of SC County
  • University/College
  • Volunteer Center
  • Friend/Colleague
  • Presentation given @ workplace/sports league
  • Google search (mentoring)
17.
Driver's License #:
18.
Do you have access to a car? *
  • Yes
  • No
19.
Do you have auto insurance? *
  • Yes
  • No
20.
Name of car insurance company:
21.
Employer: *
22.
Occupation:
23.
Length of Employment:
24.
Work Hours:
25.
Contact at Work:
26.
Do you have children? *
  • Yes
  • No
27.
Siblings Info (How many & their ages): *
28.
Years of High School:
29.
Years of Trade School:
30.
Years of College:
31.
Do you plan to take classes or return to school? If so, please explain.
32.
How long at Current Address: *
33.
Do you rent or own? *
  • Rent
  • Own
34.
With whom do you live? *
35.
Do you plan to move?
36.
Please list your previous THREE addresses (in the past 5 years) and the dates at each address:
37.
Name of Current Employer Supervisor (OR Current Professor): *
38.
Phone for Current Employer Supervisor (OR Current Professor) *
39.
Address, City, State, and Zip Code:
40.
Name of Personal Reference #1 (Please Note: References should not be family members or relatives. Thank you!): *
41.
Personal Reference #1 Phone: *
42.
Reference #1 Street Address, City, State, and Zip Code:
43.
Name of Personal Reference #2: *
44.
Reference #2 Phone: *
45.
Reference #2 Street Address, City, State, and Zip Code:
46.
Name of Personal Reference #3: *
47.
Reference #3 Phone: *
48.
Reference #3 Street Address, City, State, and Zip Code:
49.
What specific interests and aspects of yourself would you offer as a volunteer?
50.
Please list present membership in organizations and clubs (include offices held):
51.
Please list your volunteer experience (especially with children):
52.
Have you ever been a Big Brother or Big Sister (or been in a similar program)? If so, what program and where? (Please include name or agency and telephone number):
53.
Previous Employer #1 Name:
54.
Your Position #1:
55.
Dates Employed #1:
56.
Reason for leaving #1:
57.
Previous Employer #2:
58.
Your Position #2:
59.
Dates Employed #2:
60.
Reason for leaving #2:
61.
Previous Employer #3:
62.
Your Position #3:
63.
Dates Employed #3:
64.
Reason for leaving #3:
65.
Previous Employer #4:
66.
Your position #4:
67.
Dates Employed #4:
68.
Reason for leaving #4:
69.
Are you planning any change in occupation (place of employment, promotion, etc) within the next year? If so, please explain: *
70.
List three things you like about yourself: *
71.
List three things you would like to change about yourself: *
72.
What appeals to you most about becoming a Big Brother or Big Sister: *
73.
What apprehensions or hesitations do you have concerning this commitment? *
74.
Please indicate your language of preference: *
75.
Please list other languages you are fluent in:
76.
Do you use social networking sites such as blogs, myspace or facebook? *
  • yes
  • no