VOLUNTEER INFORMATION - Big Brothers Big Sisters of the Pembina Valley

VOLUNTEER application form - EN

Personal Reference

Volunteer Personal Reference Form

Reference Name*
Reference for...*
How long have you known the applicant and in what capacity?
Did you know the application was applying to be a mentor?
- Yes
- No
If so, what was your reaction?
What is it like to have the applicant as a friend?
What personal strengths do you feel the applicant has to offer?
Based on your knowledge of the applicant, to whom would he/she turn to for support or gudiance?
Can you tell me about the applicant's community involvement and personal interests?
Can the applicant be counted on to follow through on the commitments he/she undertakes?
- Yes
- No
When have you witnessed the applicant interacting with children? How does the applicant interact with or relate to children?
Have you ever known the applicant to be inappropriate (emotionally, physically, verbally, sexually) with either adults or children?
- Yes
- No
If so, please explain:
To your knowledge, has the applicant ever had any trouble following the rules?
- Yes
- No
If so, what kind of rules?
Is there anything that you are aware of that may interfere with the applicant's ability to mentor or that would cause their commitment to our organization to come to an end?
- Yes
- No
Has the applicant experienced an addiction, health or emotional concern that may impact his/her ability to participate actively in a match?
- Yes
- No
Would anything need to change in the applicant's home environment to be suitable for a child's visit?
- Yes
- No
Would you allow the applicant to develop a one-to-one relationship with your child or a child you care about?
- Yes
- No
If not, why not?
Would you recommend the applicant as a mentor for a child or youth?
- Yes
- No
Is there anything else you would like to add that would aid us in our decision?
Phone
This field is for validation purposes and should be left unchanged.

Employment Reference

Volunteer Personal Reference Form

Reference Name*
Reference for...*
How long have you known the applicant and in what capacity?
Did/Does the applicant report directly to you?
- Yes
- No
Did you know the application was applying to be a mentor?
- Yes
- No
If so, what was your reaction?
What personal strengths do you feel the applicant has to offer?
Based on your knowledge of the applicant, to whom would he/she turn to for support or gudiance?
Can the applicant be counted on to follow through on the commitments he/she undertakes?
- Yes
- No
To your knowledge, has the applicant ever had any trouble following the rules?
- Yes
- No
If so, what kind of rules?
Are you aware of any complaints being made or disciplinary actions being taken against the applicant?
- Yes
- No
Would you recommend the applicant as a mentor for a child or youth?
- Yes
- No
Is there anything else you would like to add that would aid us in our decision?
Comments
This field is for validation purposes and should be left unchanged.

Significant Other Reference

Volunteer Personal Reference Form

Reference Name*
Reference for...*
How long have you known your partner?
Did you know your partner was applying to be a mentor?
- Yes
- No
If so, what was your reaction?
Are you supportive of your partner's application to become a mentor?
- Yes
- No
What is it like to have the applicant as your partner?
How much free time does your partner have?
What personal strengths do you feel your partner has to offer?
Based on your knowledge of your partner, to whom would he/she turn to for support or gudiance?
Can you tell me about your partner's community involvement and personal interests?
Can your partner be counted on to follow through on the commitments he/she undertakes?
- Yes
- No
When have you witnessed your partner interacting with children? How does the applicant interact with or relate to children?
Have you ever known your partner to be inappropriate (emotionally, physically, verbally, sexually) with either adults or children?
- Yes
- No
If so, please explain:
To your knowledge, has your partner ever had any trouble following the rules?
- Yes
- No
If so, what kind of rules?
Are you aware of any complaints being made or disciplinary actions being taken against your partner?
- Yes
- No
Is there anything that you are aware of that may interfere with your partner's ability to mentor or that would cause their commitment to our organization to come to an end?
- Yes
- No
Has your partner experienced an addiction, health or emotional concern that may impact his/her ability to participate actively in a match?
- Yes
- No
Would anything need to change in your home environment to be suitable for a child's visit?
- Yes
- No
Would you recommend you partner as a mentor for a child or youth?
- Yes
- No
Is there anything else you would like to add that would aid us in our decision?
Phone
This field is for validation purposes and should be left unchanged.

Family Reference

Volunteer Personal Reference Form

Reference Name*
Reference for...*
How long have you known the applicant and in what capacity?
Did you know the application was applying to be a mentor?
- Yes
- No
If so, what was your reaction?
What personal strengths do you feel the applicant has to offer?
Based on your knowledge of the applicant, to whom would he/she turn to for support or gudiance?
Can you tell me about the applicant's community involvement and personal interests?
Can the applicant be counted on to follow through on the commitments he/she undertakes?
- Yes
- No
When have you witnessed the applicant interacting with children? How does the applicant interact with or relate to children?
Have you ever known the applicant to be inappropriate (emotionally, physically, verbally, sexually) with either adults or children?
- Yes
- No
If so, please explain:
To your knowledge, has the applicant ever had any trouble following the rules?
- Yes
- No
If so, what kind of rules?
Is there anything that you are aware of that may interfere with the applicant's ability to mentor or that would cause their commitment to our organization to come to an end?
- Yes
- No
Has the applicant experienced an addiction, health or emotional concern that may impact his/her ability to participate actively in a match?
- Yes
- No
Would anything need to change in the applicant's home environment to be suitable for a child's visit?
- Yes
- No
Would you allow the applicant to develop a one-to-one relationship with your child or a child you care about?
- Yes
- No
If not, why not?
Would you recommend the applicant as a mentor for a child or youth?
- Yes
- No
Is there anything else you would like to add that would aid us in our decision?
Name
This field is for validation purposes and should be left unchanged.

Previous Volunteer Experience Reference

Volunteer Personal Reference Form

Reference Name*
Reference for...*
How long have you known the applicant and in what capacity?
Did the applicant report directly to you?
- Yes
- No
What was the applicant's role in your organization?
How long did the applicant volunteer?
Did the applicant take on more responsibility or additional roles as time passed?
- Yes
- No
Did the applicant receive support and/or training?
Why did the applicant resign their volunteer role?
Did you know the application was applying to be a mentor?
- Yes
- No
If so, what was your reaction?
What personal strengths do you feel the applicant has to offer?
Based on your knowledge of the applicant, to whom would he/she turn to for support or gudiance?
Can the applicant be counted on to follow through on the commitments he/she undertakes?
- Yes
- No
Have you ever known the applicant to be inappropriate (emotionally, physically, verbally, sexually) with either adults or children?
- Yes
- No
If so, please explain:
To your knowledge, has the applicant ever had any trouble following the rules?
- Yes
- No
If so, what kind of rules?
Are you aware of any complaints being made or disciplinary actions being taken against the applicant?
- Yes
- No
Would you recommend the applicant as a mentor for a child or youth?
- Yes
- No
Is there anything else you would like to add that would aid us in our decision?
Name
This field is for validation purposes and should be left unchanged.