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 (2 to 4 times a month for at least a year)
  • After-School Program (Tues or Wed, 2:30-5:30pm, -for at least 6 months- in 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 be spouse/partner/roommate and two additional personal references): *
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