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The Organization

VIEWS: 11 PAGES: 9

									       Thank you for your interest in becoming a volunteer with Big Brothers
Big Sisters of Cleveland County. The Big Brother Big Sister concept is to
provide a one to one friendship between a responsible adult volunteer and a
child from a single parent family.
       You have the opportunity as a Big Brother or Big Sister to make a
meaningful contribution to a young child’s life. This is a commitment that
requires not only your time but also sharing your most precious gift-
yourself. This is a commitment that requires careful consideration.
       The Big Brother or Big Sister spends consistent weekly contact with
the Little Brother or Sister. The expectation is that each volunteer will
make a commitment of one year, and the anticipation is that the commitment
to the friendship will continue as long as is feasible. The longer the
friendship, the more beneficial to everyone.

                      4 Objectives of a BIG
                  •To be a responsible adult role model

                  •To develop and maintain a
                  relationship

                  •To encourage open and honest
                  communication

                  •To provide opportunity for
                  constructive leisure activity


                       The Organization
         Big Brothers Big Sisters is a non-profit organization that is
  governed by a board of directors. The Board is comprised of individuals
  representative of the community as well as Big Brother Big Sister
  volunteers.
         The agency is funded 100 percent by donations from the
  community. We receive 45 percent of our annual budget from the
  United Way. The remaining 55 percent is raised through various fund
  raising events, with the major fund-raiser being the Bowl for Kid’s Sake
  Campaign.
         We match children between the ages of 6 and 15 years old from
  single parent families.
              Application Checklist



q Completed Application, including photo and completed
  references
q Signed Confidentiality Policy
q Notarized Norman Police Record Check
q Copy of Driver’s License and Auto Insurance Policy
q Check for $15.00 for the OSBI check (make it out to Big
  Brothers Big Sisters of Cleveland County)



The Volunteer screening process takes approximately four weeks,
or more, to complete, depending upon how quickly references are
contacted, availability for interviews, and seasonal influx of
volunteers, etc. Some things you can do to help speed up the
process:

     • Contact your references and let them know to expect a
     reference call form Big Brothers Big Sisters of Cleveland
     County.

     • If you are unable to attend a scheduled appointment,
     please phone the office as soon as possible to let your Case
     Manager know so you can reschedule.
     Guidelines for the Big / Little Match Friendship
1.   The Big serves as an important role          8. The Big should be a dependable
     model for the child and as such is               friend. The volunteer agrees to see
     asked to demonstrate a responsible               the child weekly and to keep
     lifestyle.                                       appointments with the child. The Big
2.   Bigs are friends. It is important to             should check with the parent when
     develop     a    dependable       trusting       the little is picked up and should
     relationship that encourages open and            inform the parent where they are
     honest communication.                            going and when they will return.
3.   This is a friendship between one adult           Advance notice should always be given
     and one child. The Big is encouraged             if an appointment must be postponed
     to minimize the inclusion of family or           or canceled.
     friends in activities, particularly in       9. The Big does not encourage overnight
     the beginning of the friendship. The             visits with the Little. No overnight
     Big is not a parent, but a friend. It is         visits are allowed within the first six
     important not to get involved in the             months of the match. After that
     discipline of the Little.                        point, overnight visits must first be
4.   The Big is encouraged not to spend               cleared with the Big Brothers Big
     time in the Little’s home, to prevent            Sisters office. If an overnight does
     interference from siblings.                      occur, the Big guarantees that the
5.   The legal responsibility of the Big is           Little will have separate sleeping
     limited to the expectation to exercise           arrangements.
     reasonable and prudent judgement,            10. The use of alcohol or drugs by the Big
     particularly in matters of safety. Big           while on match activities is absolutely
     Brothers Big Sisters is responsible              prohibited.
     for maintaining adequate liability           11. The     Case    manager     should    be
     insurance on car and home in case of             contacted if a problem arises in the
     an accident to make sure the child is            match in any way. The Case Manager
     covered.                                         can help the volunteer by supplying
6.   The financial responsibility for                 additional information or directing the
     activities is primarily that of the Big          volunteer by supplying additional
     Brother or Big Sister, although                  information or directing the volunteer
     expenses may be shared depending on              to the best community resource.
     the financial situation of the family        12. The Case Manager should be advised
     and the age of the child.                        of     any    changes    in    address,
7.   Big Brothers and Big Sisters are                 employment, or telephone number.
     requested to participate with their              This will allow for uninterrupted
     Little in the agency’s annual fund               service of the match.
     raising event, The Bowl for Kids’ Sake       13. The Big agrees to a minimum one-year
     Campaign. They are also encouraged               commitment with the child. In the
     to attend agency sponsored group                 event that the Big is no longer able to
     activities so the child may have the             continue their contact with the child,
     experience       of       sharing     and        the volunteer is responsible for telling
     participating in a group.                        the child with the guidance of the
                                                      Case Manager.
            Big Application
                                                                    Place Photo Here
Name _______________________ Maiden _______________
Address __________________________________________
City __________________ State _____ Zip ____________
Phone (H) ___________________ (W) ___________________

Place of Employment _________________________________
Job Title __________________ Calls @ work? _ Yes _No Hours _______ Started __________
Social Security #______________ DOB ____________ Sex _____          Race _____________
Religion _____________     Own/ Access to a car? ________ Driver’s License # ___________
License Tag # _______________________ Insurance Company ____________________

Marital Status _ Single _ Married _ Separated _ Divorced _ Widowed        Year ________
Spouse’s Name ___________________________ Age ________ Occupation ______________
Names/ DOB of children ________________________________________________________
Names/ DOB of individuals living with you:___________________________________________
___________________________________________________________________________

Emergency Contact: _____________________ Phone: __________ Relationship _____________

Education:
High School ___________________________________________ Graduated ______________
College _________________________ Degree _______________ Graduated ______________
Trade School _____________________ Certificate ____________ Graduated _____________
Military Service: Branch __________ Rank __________ Served ________ Discharged ________

Employment History
Employer                       City/ State               Position         Dates
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Professional/ Social/ Civic Organizations ____________________________________________
___________________________________________________________________________

Have you been a Big before? _ No _ Yes             When?__________ Where?_____________
Have you ever applied to our agency before? _ No__Yes    When? _______________________

List any Big Brothers Big Sisters employees, volunteers, parents or Board members that you know:
___________________________________________________________________________
___________________________________________________________________________
References

Employee Reference (if not currently employed, add an extra character reference)
Place of Employment ________________________________
Position _________________________________________
Name of Supervisor ________________________ Telephone ____________________
Address _______________________ City ___________ State _____ Zip __________
Family Member Reference
Family Member ____________________________ Relationship ___________________
Address _______________________ City ___________ State _____ Zip __________
Telephone (H) ___________________ (W) ____________________
Character References
Name __________________________________________
Phone (H) __________________ (W) _________________
Address______________________ City _____________ State _____ Zip __________
Relationship ___________________________ How Long? _______________________

Name __________________________________________
Phone (H) __________________ (W) _________________
Address______________________ City _____________ State _____ Zip __________
Relationship ___________________________ How Long? _______________________

(Extra Reference)
Name __________________________________________
Phone (H) __________________ (W) _________________
Address______________________ City _____________ State _____ Zip __________
Relationship ___________________________ How Long? _______________________



        I am applying to become a Big and agree to cooperate fully with all agency
requirements in a timely manner. I understand that all of the information which I have
given and will give to the professional staff of the agency may be substantiated and any
statements found to be incomplete, incorrect or misleading may make me ineligible for
participation in the Big Brothers Big Sisters Program.
        I understand that all personal information is confidential, except that information
may be shared on a need to know basis with the parent/ guardian of a child being considered
as a match for me. All documents and information become the property of the agency.
        I understand that Big Brothers Big Sisters of Cleveland County is under no
obligation to accept me as a Big Brother Big Sister volunteer.

Date ________________ Signature ________________________________________

I agree that identifying information, including name, and photograph, may be used in agency
publications, promotional materials and recruitment campaigns without financial
consideration.
Date ________________ Signature ________________________________________
                  CONFIDENTIALITY POLICY
                            TO BE READ AND SIGNED BY AGENCY CLIENTS AND VOLUNTEERS

Access to Confidential Records

In order for Big Brothers/Big Sisters of Cleveland County, Inc. to provide a responsible and professional service to clients
it is necessary for volunteers, clients and parents or guardians of clients to be asked to divulge extensive personal
information about themselves and their families. The agency respects the confidentiality of client and volunteer records
and, with the exception of situations listed below, shares information about clients and volunteers only among the
agency professional staff.
The right to confidentiality applies to written records.

All records are considered the property of the agency and not the agency workers or clients or volunteers themselves. In
order to provide a service, which is in the best interest of the children served by the program, information from outside
sources,
including confidential references must be assessed along with information gained from the clients or volunteers
themselves. Records are not available for review by the clients or volunteers. Clients and volunteers shall be provided,
at the time of application, a copy of this statement of confidentiality along with the exceptions that define the limits of
confidentiality. Clients and volunteers shall sign a statement that he/she has read and understands the agency policy
on confidentiality and agrees to program participation under the guidelines it sets forth.

Limits of Confidentiality

1.      Information will be released to other individuals or organizations only upon presentation of an authorized
        "consent to release information" form appropriately signed by the client or volunteer.

2.      For purposes of program evaluation, audit, or accreditation, and with the prior approval of the Board of Directors,
        certain outside bodies such as Big Brothers/Big Sisters of America may have access to client and volunteer
        records. These outside organizations shall be required to respect the agency policy on confidentiality. Outside
        parties shall be required to use information only for the purpose(s) stated in the approval action of the Board of
        Directors. Known violations of the agency confidentiality policy will be reported to the supervisor of the individual
        involved and appropriate disciplinary action shall be requested.

3.      Members of the Board of Directors have access to client files only upon authorization by formal motion of the
        Board of Directors. The motion shall state who shall be authorized to review records, the specific purpose for
        such review and the period of time during which access shall be granted. Members shall be required to comply
        with the agency policies on confidentiality and may use the information only for purposes stated by the approved
        action of the Board President. A violation of the agency's confidentiality policy by a Board Member shall
        constitute adequate cause for removal from office.

4.      Information shall only be provided to law enforcement officials or the courts pursuant to a valid and enforceable
        subpoena, certified court order or signed release.

5.      Information shall be provided to an agency's legal counsel in the event of litigation or potential litigation involving
        the agency. Such information is considered privileged information, and its confidentiality is protected by law.

6.      State laws mandates that suspected child abuse be reported to the appropriate authorities (Cleveland County
        Department of Human Services). All workers are responsible for staying abreast of such reporting requirements
        of their respective jurisdiction and shall always comply with mandated procedures.

7.      If an agency worker receives information indicating that a client or volunteer may be dangerous to him or herself
        or others, necessary steps may be taken to protect the appropriate party. This may include a medical referral or
        a report to the local law enforcement authorities.

I have read and understand the above document that states the agency policy with respect to confidentiality of client
and volunteer records. I agree to program participation under the conditions it sets forth.


Client's/Volunteer's Name                                                                                    Date
                                                                                       Request for
                                                                                      Police Record
                                                                                          Check
                                                                                      Norman Police
                                                                                       Department
Please Print

Legal Name____________________________ Maiden Name_____________________

                First       Middle        Last

DOB_______________________ Place of Birth ______________________________
Social Security Number __________________________________
Driver’s License:   State ___________Number _______________________________

List all addresses for the past five years starting with current address:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________



                 FOR USE BY NORMAN POLICE DEPARTMENT
Date of Request ___________________ Reply Requested By ___________________
Case Manager _____________________

_ No Record has been found for the above named individual
_ The following Record has been found for the above named individual:

_ Norman Police Department
Date                Offense                           Disposition
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

_ O.S.B.I.      _ N.C.I.C.        _ ___________________                 _ _____________________

Date              Offense                             Disposition
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

By Records Division _____________________________ Date ____________________

To be submitted by Big Brothers Big Sisters of Cleveland County, Inc.
               Authorization for Release of Personal Information

I, ______________________________, do hereby authorize the City of Norman Police
Department, the City of Moore Police Department, the Cleveland County Sheriffs
Department and the District Court of Cleveland County to Release the Big Brothers Big
Sisters of Cleveland County, Inc. any and all records concerning myself, whether the
said records are of a public, private or confidential nature.

The intent of this authorization is to give my consent for full and complete disclosure of
the records of all local, state, and federal law enforcement agencies. I authorize the
release of records concerning, but not limited to, my driving record, arrest records,
conviction data and investigations of crimes committed or alleged to have been
committed by me.

I hereby release and hold harmless the above mentioned agencies, as custodians of such
records, including all officers, employees and related personnel, both in their individual
and official capacities, from any liability incurred as a result of their releasing the above
information.

I understand that all information will be held in confidence and become the property of
the agency.

A photocopy of the release shall be as valid as the original, even though the said
photocopy does not contain an original writing of my signature.

Please Print
Full Name ______________________________________ Maiden _________________

Signature _______________________________________________________________

Address ________________________________________________________________

City ______________________ State _______________ Zip _____________________

Subscribed and sworn before me this ____________ day of ________________, 20____.




Notary
My commission expires ______________


Big Brothers Big Sisters of Cleveland County, Inc. will notarize.
       Individual Request For Criminal History Record Inspection Non-
                    Commercial or Employment Purposes

This request is being made of the Oklahoma State Bureaus of Investigation as the
designated statuary criminal history record repository for the purpose of checking my
personal record for accuracy. I agree to notify the OSBI and the submitting agency of
any entry that is incorrect. I agree to submit court documents supporting any challenge to
the accuracy.

It is understood and agreed that this request is not to be used for commercial or
employment purposes and is permitted once after an involvement with a criminal justice
agency or initially to determine a record of existence, all other name checks shall be
charged at the rate of $15.00 per check pursuant to Oklahoma Statute.




Please search arrest records for:

Name___________________________________________________________________
     First                   Middle                  Last

Date of Birth ____________________________________________________________

Race ___________________________ Social Security # _________________________


Signed _________________________________________ Date ____________________

								
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