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Big Brothers Big Sisters of Southeastern New Mexico


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Volunteer » Application Process » Apply Online

Personal Info
First Name:
Middle Name:
Last Name:
Home Phone:
Cell Phone:
Email:
Ethnicity:
Gender:	Male Female
Birth Year:
Fluent in Spanish:	Yes No

Employment Info
Employer:
Title:
Address:
Work Phone:
May we call you at work?	Yes No

Residential History
Please list all residences from current back for the last 5 years. The information you provide will be used to conduct a criminal records background check through various local, state, and national databases.
Current Home Info
Address:
City:
County:
State:	Zip:
From Date:
To Date:
Most Previous Home Info
Address:
City:
County:
State:	Zip:
From Date:
To Date:
2nd Previous Home Info
Address:
City:
County:
State:	Zip:
From Date:
To Date:
3rd Previous Home Info
Address:
City:
County:
State:	Zip:
From Date:
To Date:

References
Please DO NOT list any relatives as references even if they fit one of the reference types. If you have been in counseling in the past two years, please list your counselor. If others reside with you, use one as a reference. Please list your supervisor if you are employed. Community Program: all three references are required; please list friends, co-workers, or others if the above does not apply to you. School Based Program: you only need to fill out one reference. Please provide your references email addresses where available as this helps us save time and resources by automatically contacting them when you submit this form.
Professional Reference - Supervisor or teacher who has known you for at least ONE year
Type:
Name:
Address:
Phone:
Fax:
Email:
Coworker or Friend - Who has known you at least TWO years
Type:
Name:
Address:
Phone:
Fax:
Email:
Spouse/Domestic Partner/Friend - Who has known you for at least THREE years
Type:
Name:
Address:
Phone:
Fax:
Email:

Program Interests
Program interest:	Community Program School Based
	Other:
Please tell us how you heard about BBBS:

	Other:
Have you ever applied to Big Brothers Big Sisters? If so, where and when?


Comments

By submitting this form, I am indicating that I understand and agree to the following: The references I listed may be contacted by mail, telephone, or email This application in no ways obligates me to perform any volunteer services 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 Our BBBS agency is not obligated to match you with a youth As part of our enrollment processes, we will be asking you to provide additional personal information prior to make any recommendations for assignment. I authorize my counselor (if applicable) to release any pertinent information contained in my records or files regarding my suitability to be a volunteer for BBBS Southeastern New Mexico which by law or otherwise, may be considered confidential or privileged. This consent expires when I have fulfilled my commitment to the BBBS Pecos valley agency and when I am no longer an active volunteer. I release the above named from any damages because of furnishing such information.