Big Brothers Big Sisters of Central Arkansas
628 W. Broadway, Suite 102
North Little Rock, AR 72114
VOLUNTEER
APPLICATION
(Please bring this form with you to your interview or mail it to us prior to first interview)
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First
Name:
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Middle
Name: |
Last
Name: |
Date
of Birth: |
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Home
Address:
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City: |
County: |
State: |
Zip: |
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Email:
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Home
Ph #: |
Work
Ph #: |
FAX: |
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Male Female |
Social
Security #: |
Employer:
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Address:
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City: |
State: |
Zip: |
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Occupation:
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Ethnicity: |
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Can
We Contact You At Work:
_____Yes _____No |
Work
Hours:
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How
Long Employed:
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Possession
of a driver’s license is not a requirement to participate in any of
our programs but is required if you will be transporting a youth in
any vehicle you are operating. |
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Do
you have a driver’s license?
_____Yes _____No |
If
yes, state of issue and #
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Expiration
date:
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Please type or print information requested
for three references: 1) your current or past employer
who has known you for at least 1 year; 2) a co-worker or friend who has known you for at least 2 year; and
3) a close family member (spouse/domestic
partner) or a second friend who has known you for at least 3 years.
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1.
Employer’s Name (or school if
student):
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Supervisor’s
Name (or teacher if a student):
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Address:
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City: |
State: |
Zip: |
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Day
Phone #:
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Fax
#:
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Email:
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2.
Coworker or Friend:
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Address:
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City: |
State: |
Zip: |
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Day
Phone #:
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Fax
#:
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Email:
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3.
Spouse/Domestic Partner/Friend:
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Address:
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City: |
State: |
Zip: |
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Day
Phone #:
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Fax
#:
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Email:
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Have
you ever applied before to be a Big Brother or Big Sister? Yes
______ No______ |
Where
and When: |
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At
this time, which of our programs to you feel most interested in?
_____ Community-Based _____Other Program _____ School-Based |
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I
understand that:
1)
the references I
listed may be contacted by mail, telephone, or email;
2)
this application
in no ways obligates me 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)
our BBBS agency is
not obligated to match you with a youth
5)
as part of our enrollment
processes, we will be asking you to provide additional personal information
prior to make any recommendations for assignment.
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Signature Date