**Please take a moment to review the entire application and gather any necessary information before you begin. You cannot save the application mid-process. BBBS of Santa Cruz County does not sell or share any personal information under any circumstances.
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First Name:
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Middle Initial:
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Last Name:
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Birthdate:
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Driver's License #:
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Address:
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City:
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Zip Code:
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Primary Phone:
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Secondary Phone:
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Best Time to Call:
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Email Address:
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Employer:
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Occupation:
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Length of Employment:
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Work Hours:
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Contact at Work?
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Birthplace:
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Siblings Info (How many & their ages):
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Ethnicity:
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Sex:
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Years of High School:
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Years of Trade School:
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Years of College:
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Do you plan to take classes or return to school? If so, please explain.
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How long at Current Address:
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Rent or Own:
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With whom do you live?
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Do you plan to move?
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Please list your previous THREE addresses (in the past 5 years) and the dates at each address:
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Employer Reference:
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Employer Phone:
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Employer's Street Address, City, State, and Zip Code:
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Name of Personal Reference #1:
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Reference #1 Phone:
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Reference #1 Street Address, City, State, and Zip Code:
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Name of Personal Reference #2:
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Reference #2 Phone:
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Reference #2 Street Address, City, State, and Zip Code:
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Name of Personal Reference #3:
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Reference #3 Phone:
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Reference #3 Street Address, City, State, and Zip Code:
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What specific interests and aspects of yourself would you offer as a volunteer?
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Please list present membership in organizations and clubs (include offices held):
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Please list your volunteer experience (especially with children):
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Have you ever been a Big Brother or Big Sister (or been in a similar program)? If so, what program and where? (Please include name or agency and telephone number):
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Previous Employer Name:
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Your Position:
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Dates Employed:
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Reason for leaving:
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Previous Employer #2:
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Your Position:
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Dates Employed:
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Reason for leaving:
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Previous Employer #3:
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Your Position:
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Dates Employed:
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Reason for leaving:
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Previous Employer #4:
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Your Position:
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Dates Employed:
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Reason for leaving:
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Are you planning any change in occupation (place of employment, promotion, etc) within the next year? If so, please explain:
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List three things you like about yourself:
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List three things you would like to change about yourself:
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What appeals to you most about becoming a Big Brother or Big Sister:
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What apprehensions or hesitations do you have
concerning this commitment?
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Please indicate your language of preference:
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Please list other languages you are fluent in:
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Do you have access to a car?
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Do you have auto insurance?
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Name of insurance company:
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Do you have homeowners'/renters' insurance?
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Name of insurance company:
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