BIG BROTHERS BIG SISTERS

Serving Lackawanna, Susquehanna, and Wayne Counties

Volunteer Application

Please provide the following information. When you are done, use the submit button to send the application. You will be contacted once your application is received.

First name:

Middle initial: 

Last name:

Street address:

Address (cont.):

City:

County:

State:

ZIP:

   

Home Phone:
Best Time To Call At Home Do Not Call

Work Phone:
Best Time To Call At Work Do Not Call

 

  

E-mail:

Date of birth:

Sex: 

Male Female

Employer Occupation

Have you applied to be or served as a Big Brother/Big Sister before?
Yes        No

When and Where?

 
Briefly describe any paid or volunteer experiences with youth.

Organization Location
Dates Type of Involvement

Organization Location
Dates Type of Involvement

Organization Location
Dates Type of Involvement

List persons involved in BBBS whom you know:

Why do you want to be a Big Brother/Big Sister?

 

SELF SCREEN ELIGIBILITY CHECK LIST

Please select each item to affirm your ability to be considered for acceptance. The agency will verify eligibility through interviews, personal/professional references, employment, and police /driving record check. If you have any questions regarding eligibility and/or significant changes, please contact the Big Brothers Big Sisters office at 570-347-5616.

To Be Eligible for Consideration, A Big Brother/Big Sister Must:

Be 18 or older
Be in good physical and mental health
Be stable in interpersonal relationships
Provide child w/ safe & positive influences
Safe Driver w/ valid license
Have Insurance and own transportation
No recent history (5 yrs) of DUI
No recent history of reckless driving
No recent history of license suspension
Be free of alcohol abuse/dependency-2yr.
No illegal drug/controlled substance use-2yr
No felony record
No criminal record involving harm to others

SIGNIFICANT CHANGES AFFECTING COMMITMENT

Your time commitment to a child is very important, and we have learned from experience that several key factors are significant when we evaluate a person's ability to make this commitment. Please select any of the following conditions that may apply to you so that we may discuss them with you and determine how to best proceed with the timing of your request to serve as a Big Brother/Big Sister volunteer.

Select any of the following options that apply:

A change in marital status within 6 months
A change in parenthood within 6 months
A change in employment w/in past 30 days
A change in employment within 6 months
A change in residence w/in next 6 months
Any significant changes in personal life

Please describe changes in personal life in box below:

 

REFERENCES

Please type in names, mailing addresses, and phone numbers of three (3) people who have known you well for at least two (2) years and whom we may contact to provide a personal reference for you.  Please do NOT list relatives or dating relationships.

IT IS ADVISABLE THAT YOU INFORM YOUR REFERENCES THAT WE MAY BE CONTACTING THEM AND TO ENCOURAGE THEIR PROMPT REPLY SO AS NOT TO DELAY YOUR APPLICATION.
Name Address
City, State, Zip Phone
Name Address
City, State, Zip Phone
Name Address
City, State, Zip Phone

I HAVE READ THE PROGRAM INFORMATION, CHECKED THE ELIGIBILITY GUIDELINES AND SIGNIFICANT CHANGES CHECKLIST AND PROVIDED 3 REFERENCES AS REQUESTED AND HEREBY SUBMIT MY APPLICATION FOR CONSIDERATION.

Date Submitted

THANK YOU FOR YOUR INTEREST IN HELPING A CHILD.
ONE PERSON CAN REALLY MAKE A DIFFERENCE!

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Voluntary Action Center
 Scranton Life Building
538 Spruce Street, Suite 420  
 Scranton, PA 18503
Phone: (570) 347-5616
 E-mail: