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Volunteer Application:
Please Print Out and Submit to:
Jersey Shore Big Brothers Big Sisters
301 Third Street
Ocean City, NJ 08226
Atlantic: 484-9480 Cape May: 391-8008 Fax: 398-7646
Email: myrabelasco@hotmail.com
Jersey Shore Big Brothers Big Sisters is a social service agency whose goal is to help children who may be at risk in the community. These are children who may be having some difficulty in their lives, and who will benefit from the friendship, support and experience of having a Big Brother or Big Sister. Volunteers are mature adults who can provide a stable consistent relationship to a child on a one-to-one basis. All information received is confidential and becomes the property of the agency. Jersey Shore Big Brothers Big Sisters does not discriminate on the basis of race, ethnicity, age, sexual orientation, religion or physical disability. This is the first step in a thoughtful process of assessment and orientation to the program. Please make plans to attend an upcoming orientation meeting. Once this application is received and all references (see reverse) have been contacted, a case manager will contact the applicant to arrange personal interviews.
Name: ______________________________________________________________________
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First |
MI |
Last |
Present Address:_______________________________________________________________.
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No |
Street |
City |
State |
ZIP |
Home telephone: ___________________Work telephone: _______________Ext. ________
Can you receive calls at work? _______________________
Date of Birth: ____________Religion: ____________Race: ____________
Educational Background: ___________________________________________________________
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School |
Degree/Diploma |
Year |
Employer (if student, list school): _________________ Telephone: _____________________
Employer’s address: __________________________________________________________
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No |
Street |
City |
State |
ZIP |
Job title/duties____________________ How long with present employer: ___________
Martial Status:
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Single |
Single Living with partner |
Engaged |
Married |
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Separated |
Divorced |
Widowed |
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Have you ever been arrested? If yes please include dates _________ and circumstances:
__________________________________________________________________________
__________________________________________________________________________
1. CURRENT EMPLOYER OR SUPERVISOR (advisor or Professor if in school)
Name: ____________________________Relationship: _______________________
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Title (Mr./Mrs./Ms.) |
First |
Last |
Address: ____________________________________________________________________
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Company/School |
No. Street |
City |
State |
ZIP |
Telephone: (____)______-__________ Months/Years Supervised: __________________
2. LONG TERM FRIEND (Non-relative; At least one year)
Name: ______________________________________Relationship: __________________
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Title (Mr./Mrs./Ms.) |
First |
Last |
Address: ______________________________________________________________________
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Company/School |
No. Street |
City |
State |
ZIP |
Telephone: (___)____-__________Work telephone: (___)_____-______Years known: _____
3. LONG TERM FRIEND (Non-relative; At least one year)
Name: _______________________________Relationship: __________________________
|
Title (Mr./Mrs./Ms.) |
First |
Last |
Address: ________________________________________________________________
|
Company/School |
No. Street |
City |
State |
ZIP |
Telephone: (___)_____-______Work telephone: (___)____-______Years known: _____
4. LONG TERM FRIEND (Non-relative; At least one year)
Name: ______________________________Relationship: ____________________________
|
Title (Mr./Mrs./Ms.) |
First |
Last |
Address: __________________________________________________________________
|
Company/School |
No. Street |
City |
State |
ZIP |
Telephone: (___)_____-________Work telephone: (___)_____-______Years known: _____
The undersigned acknowledges and agrees that (1) he/she is not obligated, if called upon, to perform the volunteer services herein applied for and that the Agency is not obligated to assign actively , or actively seek a Little Brother/Sister. (2) as part of the Agency’s assessment process, pertinent personal information will be elicited from the applicant by professional agency personnel; (3)and a criminal record check will be made.
Date: _____________ Signed: _____________________________________________
If you have any questions feel free to email us: jsbbbs@jsbbbs.ourfamily.com