BBBSTT Online Application

First Name: Middle Name: Last Name:

Date of Birth: | Marital Status: Single Married Divorced Separated Widowed

Maiden Name: | Age: | Sex: Male Female

Street Address:

City: Country:

How long have you resided at the above address: Time Period: Years Months Weeks Days

If less than five (5) years, please provide a list of all former places of residence within that 5 year period.

Previous Residence(s):

Home Phone: Cell Phone: Personal Email:

PART B - APPLICANT EMPLOYMENT & HISTORY

Name of Employer (Company):

Employer/Company Address:

Office Phone: Office Fax: Work Email:

How long have you worked at the above establishment: Time Period: Years Months Weeks Days

If less than five (5) years, please provide a list of names and addresses of employers within that 5 year period.

Previous Employer(s):

PART C - APPLICANT SCREENING INFORMATION

I. CRIMINAL HISTORY

Have you ever been convicted of a crime? Yes No

If YES, please list the Date(s) and the corresponding charge(s) together with its disposition/verdict below.

Do you have any criminal charges pending against you? Yes No

If YES, please describe them:

II. VOLUNTEER SKILLS

Do you have any mentoring experience? Yes No

If YES, please describe them:

Why would you become a mentor in the BBBS programme?

Which activities do you enjoy: Sports/Outdoor Activities Games Music Arts & Craft Computing/Technology

Please specify activities where applicable:

III. VOLUNTEER PREFERENCES

Is there a particular child personality you would prefer to work with or feel that you would be particularly successful with? For e.g. a shy child, a child dealing with anger management, one that loves to draw or loves sports, one that is physically impared or coping with a learning disalibility?

Child Personality:

Are there particular child personalities you would prefer NOT to work with?

Child Personality:

What kind of Support/assistance could the programme offer that would be most beneficial to you?

PART D - APPLICANT REFERENCE INFORMATION

Please list the names and contact information of two (2) persons that you would like to use as testimony to your character and integrity. One (1) reference should be stated in a professional capacity and the other in a personal capacity.

PROFESSIONAL REFERENCE DATA

First Name: Middle Name: Last Name:

Work Address:

Office Phone: Mobile: Email:

How long have you known this individual?

What is your relationship with this individual?

PERSONAL REFERENCE DATA

First Name: Middle Name: Last Name:

Home Address:

Work Address:

Home Phone: Work Phone: Mobile Phone:

Email:

How long have you known this individual?

What is your relationship with this individual?

PART E - APPLICANT CONSENT & DECLARATION

By Clicking the Submit button below you authorize Big Brothers Big Sisters of Trinidad & Tobago (BBBSTT) to obtain information pertaining to my history and character, as part of the screening process for participation in the programme.

I declare that all the information I gave on the online application to the programme is true to the best of my knowledge and belief. I understand that any information that I withhold or that proves to be false upon investigation can and will affect my application for participation in the programme.

I understand that I will be given an opportunity to answer any questions that may arise from the background checks being performed.

I further understand that BBBSTT retains the right to defer or reject my application for participation in the programme, knowing that the reasons for such a decision will be made known to me.

I hereby submit this form via electronic mail and agree to this statement, in the confidence that all information disclosed to BBBSTT will be kept confidential, except if there are any legal issues which require them to be divulged. I expect that a notification will be sent to me before any such action is taken.