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Online Application

Thank you for your interest in becoming a Big Brother, Big Sister or Big Couple.  Please take a few moments to complete our online application.  The application will begin the process of becoming a volunteer.  You may choose to apply online before attending an orientation or you can choose to attend an orientation before applying.  If you choose to apply online first you must schedule a orientation.  Click here for more information on our orientations. 

Your information will be kept completely confidential and will not be shared with any other parties.  This is a secure site and we use all precautions to make sure your information is transferred securely.  Click here to view our privacy policy.
 
To ensure timely processing, please complete all relevant sections of this application.  If you're unable to answer all questions on the application, you will have the opportunity to provide the missing information at your orientation. 

*Have you had a face-to-face orientation with a BBBS staff member?
If "No", please click here to see your options for scheduling a Group or Individual Orientation.
How did you hear about BBBS?
Other:

*Your First name:

*Your Last name:

Maiden name or other names used:

 
*Birthdate:

*Social Security Number:

*Gender:
*Marital Status:
*Address:

Address 2:

County:

 
*City:

*State:  
*Zip:

*Day Phone:

Evening Phone:

 
*Primary Email:

To help us fulfill the reporting requirements of some of our funders, please identify your race:
 
Current Employer:

 
Work Phone:

 
Work Email:

 
Occupation:

 
Years Employed:

 
Regularly Scheduled Hours:

 
*Have you ever applied to be a Big Brother/Big Sister?
If yes, name of agency and month/year of application:

 
*Do you anticipate any major changes in the coming year?
If yes, please list:

 
*How do you prefer that we contact you?
*Emergency Contact Name:

*Relationship:

*Day Phone:

Evening Phone:

 
*Do you speak any languages other than English?
If yes, which languages:

 
*Have you served in the military in the past seven years?
*Do you have a valid driver's license?

Please list three adult friends who have known you for at least one year but are not related to you. Please do not list your work supervisor. Three names and phone numbers are required. Providing e-mail addresses for your references will automatically send those listed an e-mail.
  *Reference Name *Day Phone Evening Phone Email Address
Friend 1
Friend 2
Friend 3

Please list anyone you know who is or has been affiliated with our program:


 

If you've held your current job less than two years, please provide employment history, including: employer, city, state, job title, full- or part-time, date employed and reason for leaving.

Job 1


 
Job 2


 
Job 3


 

Employer Reference. Providing e-mail addresses for your references will automatically send those listed an e-mail. If self- employed or unemployed, please don't complete this section.
Employer Name:

 
Employer Address:

 
City, State Zip:

 
Work Supervisor Name:

 
Supervisor's Phone Number:

 
Supervisor's Email:

 

I hereby request and authorize my employer to complete the Big Brothers/Big Sisters of Greater Kansas City Reference Questionnaire. A photostatic copy of this authorization shall be considered as effective and valid as the original.


Insurance Release
Insurance Provider:

 
Agent Name:

 
Agent's Phone Number:

 
Automobile Insurance Policy Number:

 
Name of Policyholder (if different than volunteer):

 

I hereby request and authorize you to provide Big Brothers Big Sisters of Greater Kansas City or their representatives, information and records regarding my policy of automobile insurance coverage including, but not limited to, certificates of coverage and any other information, oral or written that will confirm that I possess a current policy of liability insurance coverage’s as mandated by the applicable state law. A photostatic copy of this authorization shall be considered as effective and valid as the original.

If your automobile is insured with one of these companies, you MUST call the company and give your permission for the release of information to Big Brothers Big Sisters of Greater Kansas City. All numbers are answered 24 hours a day, seven days a week.

Progressive: 1-800-274-4499
USAA: 1-800-531-8111
Geiko 1-800-841-3000


Policy Statement

By applying to become a Big Brother or Big Sister with Big Brothers Big Sisters of Greater Kansas City (BBBSGKC), I understand that:

To be considered for acceptance as a Volunteer, I must complete all steps of the Volunteer Application Process, which include an application, personal and employer references, background checks, automobile insurance verification, preference sheet, interview and home visit. The process may also include verification of previous volunteer service and references from physician(s) and/or mental health professional(s) if applicable. I understand that all information provided by me may be verified and I give permission for verification.

All information obtained during the Volunteer Application Process will be kept confidential. BBBSGKC will use the information to create an anonymous profile about me, which will be shared with the parents/guardians of any Little Brothers or Little Sisters I select as potential matches. I acknowledge that BBBSGKC retains and does not grant access to the information acquired through the Volunteer Application Process to me or any other parties.

Any omissions or misstatements made by me during the Volunteer Acceptance Process or any time during my association with BBBSGKC may be cause for my application to be declined or volunteer placement to be terminated.

I understand that BBBSGKC at its sole and complete discretion may accept or decline my application without providing me any reasons for the decision. I am not obligated to perform any volunteer services and BBBSGKC is not obligated to match me with a Little Brother or Little Sister.

I declare that all of the statements made during the Volunteer Application Process will be true, correct and complete to the best of my knowledge.

I have read and understand the BBBS-GKC policies and profiles statement.


 

     

 3908 Washington Street, Kansas City, MO 64111 | P: 816.561.5269 | F: 816.561.5273

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