3461 Robin Lane, Suite

2
Cameron Park, CA
95682
T 530 626 1222
www.bbbs-edc.org

Volunteer Application
First Name:

Middle Name:

Home Address:

Last Name:
City:

Date of Birth:

County:

State:

Zip:

Email:

Home Ph #:

Work Ph #:

Gender

Social Security #:

Current/ Former (if retired) Employer:

Employers Address:

Current/ Former (if retired)

Occupation:

Cell Ph #:

City:

Ethnicity:

State:

Domestic Partnership
Status:

Zip:

Highest Level of Education

(yrs):

Can We Contact You At Work:

Work Hours:

How Long Employed:

_____Yes
_____No
Do you have a drivers license?

If yes, state of issue and #

Expiration date:

_____Yes
_____No
Have you ever been convicted of a
crime?

If yes, please give date(s) of

the conviction(s)?

Please describe the nature of the

offense(s):

Yes_______ No _______
Please list any states you have resided in other than California:

References: Please type or print information requested for three references (known longer than
1. Supervisors Name/ Good friend (if self employed or teacher if a student):
Day Phone #:

Relationship w/
Reference:

Email:

Relationship w/
Reference:

Email:

Relationship w/

Email:

2. Coworker, Friend or Neighbor:

Day Phone #:
3. Spouse/Domestic Partner/Friend:
Day Phone #:

Our Mission is to provide children facing adversity with strong and enduring,
professionally supported one-to-one relationships that change their lives for the
better, forever.
Updated 2/2014 AH

Reference:

Pre-Interview Questionnaire
Occupational and Educational Information:
1. Are you currently Working/attending School? _____Yes ______No
2. What
is
your
work/
school
schedule?
_____________________________________________
3. What is your occupation or former occupation (if retired)?
___________________________
4. What
do/did
you
find
most
rewarding
about
your
job?
______________________________
5. What, if anything, would you like to change about your job?
__________________________
6. How long have/ were you in this field of work?
____________________________________
7. Why did you leave your last job?
________________________________________________
8. Where did you graduate from high school?
________________________________________
9. Did you attend college? If so, where and what was your major?
_______________________
10.Do you have any further educational goals at this time in your life?
____________________
11.Do you have any military experience? ____________
o When did you serve (dates)?_____________ Currently active?
_____________
o Job positions held & job duties performed:
_____________________________
______________________________________________________________________________
o
o Where have you been stationed? _____________
o Have you ever been deployed?__________ Where & when?
________
o Currently deployable? ____________
o IF applicable, why did you leave the service?
_____________________________
______________________________________________________________________________
Family Relationships:
1. Do you have any siblings? _____Yes _____No
2. Where
did
you
grow
______________________________________________________

up?

Our Mission is to provide children facing adversity with strong and enduring,
professionally supported one-to-one relationships that change their lives for the
better, forever.
Updated 2/2014 AH

3. What
did
your
parents
do
for
a
living?
____________________________________________
4. How would you describe your current relationships with your parents,
siblings,
and
other
family
members?
____________________________________________________________
___________________________________________________________________________
Relationship History & Friendships:
1. Are you currently married/domestic partnership or in a serious
relationship? __Yes ___No
2. How did you meet? _______________________________________________________
3. How long have you known each other? ___________________
Leisure Time
1. What are some of your hobbies/ interests/ recreational groups?
______________________
___________________________________________________________________________
2. Are you a member of any professional organizations (Bar Associations,
Rotary, etc)? ______
___________________________________________________________________________
3. What is the time commitment for the above hobbies/ organizations/ etc?
______________
4. Over the past 5 years, have there been any changes in how you spend
your leisure time? __
Why
do
you
think
that
is?
____________________________________________
5. Would you describe yourself as a person who enjoys:
_______Watching events/activities _______Participating in event/activities
______Both
6. Which do you enjoy more?
_______Indoor activities
________Outdoor activities
_________No
preference
7. Do you now or have you ever used alcohol, drugs or tobacco?
________________________
If so, how have they played a role in your leisure time?
____________________
8. Do you have a history of substance abuse in your family? _____ Yes _____
No
9. Have you ever had an alcohol or drug related accident/ incident? ____Yes
_____No
If
yes,
please
explain:
______________________________________________________
10.How often do you (and significant other, if applicable) currently consume
alcohol? ________
Our Mission is to provide children facing adversity with strong and enduring,
professionally supported one-to-one relationships that change their lives for the
better, forever.
Updated 2/2014 AH

11.Are
you
currently
taking
any
mood
altering
medication?
_____________________________
12.Are
you
undergoing
any
counseling?
_____________________________________________
13.Are you experiencing any physical or mental health problems? _____Yes
_______No
14.Have you been hospitalized in the last 5 years for physical/ mental health
reasons? ________
15.Do
you
have
a
religious
affiliation?
______________________________________________
16.How much of your free time is spent online? ___________ For what purpose?
_________
______________________________________________________________________________
17.If we were to Google you, what would we find?
____________________________________
___________________________________________________________________________
18.Thinking about whats on your personal web pages, is there anything on
there that would be inappropriate for a child to read/view?
19.Do you plan to interact with your Little online?
_____________________________________
Home Assessment:
1. Who else lives with you? (What are their relationships to you?)
____________________
2. On a scale of 1 to 10 (10 being very safe) how would you rate the
safety
of
your
neighborhood?
___________________________________________________________
3. How
long
have
you
lived
in
the
community?
___________________________________
4. Is there any chance you could be moving out of the community?
_____Yes _____No
5. Would a youth generally enjoy being around your home, why?
____________________
________________________________________________________________________
6. What are some of the things you can imagine doing with your Little at
your home? ____
________________________________________________________________________
7. Would you be able to make inappropriate viewing materials in your home
unavailable for a child?
_______Yes ______No

8. Do you have any firearms or ammunition at your house? ______Yes

______No
If
yes,
what
safety
precautions
are
set
up:
________________________________
9. Do you have any pets? ________Yes _______No Child Friendly? ______Yes
_______No
If
yes,
what
kind
of
pets:
_____________________________________________
Our Mission is to provide children facing adversity with strong and enduring,
professionally supported one-to-one relationships that change their lives for the
better, forever.
Updated 2/2014 AH

Are they up to date on their vaccinations? ______Yes _______No

Are you able to put the animal way when the child is around?
_______________
10.Both in and around your home, what do you think are some of the
safety considerations both you and youth will have to take into
account? ______________________________
Experience with Children:
1. Do you have any experience with children (other than that of raising
children)? _______
________________________________________________________________________
2.
What were the ages of the youth you worked with?
______________________________
3. For how long did you volunteer? How many hrs. per week, etc.?
____________________
4.
What
did
you
learn?
________________________________________________________
5.
What
qualities
do
you
admire
most
in
children?
__________________________________
6. What did you most enjoyed about working with children and any
challenges you had? __
___________________________________________________________________________

Personal Goals:
1. What attracted you to BBBS as a way of becoming involved in working
with youth? ____
_______________________________________________________________________
2. How
did
you
hear
about
BBBS?
_____________________________________________
3. How does this volunteering opportunity fit with your personal goals?
_______________
________________________________________________________________________
Volunteer Match Preferences:
1. What is the youngest and oldest age you see yourself working best
with? __________
2. Do you imagine yourself with a talkative child, or someone more on the
quiet side? __
____________________________________________________________________
3. Do you imagine yourself with a child who asks for your advice, or who
prefers
to
work
thing
out
on
their
own?
____________________________________________
4. Do you imagine your Little to be very active? What are some of the
activities
you
see
yourself
doing
together?
___________________________________________________
Our Mission is to provide children facing adversity with strong and enduring,
professionally supported one-to-one relationships that change their lives for the
better, forever.
Updated 2/2014 AH

5. Would you be willing to be matched with a child coming from a home

with a history of substance abuse? ____Yes _____No
6. Would you be willing to be matched with a child who had been
physically, emotionally, or sexually abused? ____Yes ____No
7. Are you comfortable working with a child that has an incarcerated
parent or loved one? ______Yes ______No
8. Are you willing to work with a child with a mental health diagnosis
(depression, PTSD, ADHD, etc.)? _____Yes ______No
9. Are you comfortable working with a child with a physical health
diagnosis (asthma, allergies, diabetes, etc)? ____Yes _____No
10.Are you comfortable working with a child receiving special education
services for a developmental delay or learning disability? ______Yes
______No
11.Would you be willing to be matched with a child in the foster care
system for our Foster Based Mentoring Program? ____Yes ____No
12.Are you comfortable working with people with other religious beliefs
than your own? _____Yes _______No
13.Are you comfortable working with a Little or family members that may
be of a different sexual orientation than your own? _______ Yes
_______No
14.How would you respond if your Little or their family asked about your
sexual orientation or your opinion of the sexual orientation of others?
_____________________________
15.How far are you willing to drive? ____________________
16.Is there anything else about yourself that we didnt get a chance to
discuss
and
that
youd
like
to
share
now?
___________________________________________________
_______________________________________________________________________
Supplemental Questions
1. What are 3 adjectives to describe you?
_____________________________________
_______________________________________________________________________
2. Have you ever applied to be or been matched as a Big Brother or Big
Sister with this or any other BBBS agency? _______Yes ________No
If yes, when and where:
_____________________________________________
3. Have you ever been involved with Big Brothers Big Sisters in any other
capacity other than as a Big? ______Yes ________No
If yes, when and where:
_____________________________________________
4. What (if any) other youth organizations have you worked for or been
involved with as a volunteer?
______________________________________________________________

Our Mission is to provide children facing adversity with strong and enduring,
professionally supported one-to-one relationships that change their lives for the
better, forever.
Updated 2/2014 AH

5. Do you know anyone involved in BBBS? ___________ What have they

shared with you about the program?
_______________________________________________________
6. Would you like to become involved with BBBS in other ways:
_______Event Help _______Fundraising Help _______Office Help
7. Do you have transportation? _______Yes ________No
8. Do you anticipate (or had recent) any major life changes? _________Yes
_________No
If yes, please explain:
_______________________________________________
9. Do you speak in foreign languages?
__________________________________________
10.Have you had any driving citations in the past 5 years? ______Yes
_______No
If yes, please explain:
_______________________________________________
11.Do you have any questions?
________________________________________________
_______________________________________________________________________
_

I understand that:
1) The references I listed may be contacted by mail, telephone or
email
2) I am, in no way, obligated to perform any volunteer services
3) The information I provided may be used to conduct a background
check, to include driving records check, criminal background
check, and other records where required by local, state, or
federal law for volunteers working with youth
4) The BBBS agency is not obligated to match me with a youth
5) Other BBBS agencies or youth organizations where I have worked
or volunteered may be contacted as references
6) I will be required to attend a pre-match training as well as the
required training sessions offered throughout the year

_________________________________________
Signature of Volunteer

________________________
Date

Our Mission is to provide children facing adversity with strong and enduring,
professionally supported one-to-one relationships that change their lives for the
better, forever.
Updated 2/2014 AH