Formulaire de candidature pour le programme de mentorat en milieu scolaire

Personal Information

* denotes that answers to these questions are mandatory

Legal Name*

Prénom Nom

Please Note: Your Legal name is required on this application. Please ensure you fill out your application using the name on your Driver’s License or Birth Certificate.

Preferred Name – If Applicable

Prénom Nom

Pronouns

Gender*

Please specify.

Date of Birth (mm/dd/yyyy)*

Address*

Adresse postale Ville Province Code postal

Telephone*

Cell

Home (N/A if none)

Business (N/A if none)

Email*

Saisissez un e-mail Confirmez l’e-mail

Languages spoken*

Other languages spoken:

If bilingual, would you be comfortable mentoring in French?*

Preferred Language of Correspondence*

Emergency Contact*

Full Name

Relationship

Telephone

What is your country of origin?*

What is your immigration status:*

Are you a visible minority?*

How long have you been in Canada?*

Are you Indigenous?*

Region/Community:

First Nations:

Métis:

Inuit:

Other (please specify):

Getting to Know Your Child

Why does your child want to be a mentor?*

Please share some of the characteristics of the child (e.g. active, outgoing, shy, friendly)*

What classes would you rather your child not miss?*

What prompted you to apply?*

Please specify:

Would you be interested in helping with Fundraising events?*

I would like to sign up for BBBSO’s Blog:*

I would like to sign up for BBBSO’s Monthly Newsletter:*

Vulnerable Sector Reference and Experience

NOTE: A vulnerable sector check is an enhanced criminal record for individuals who have volunteered with children or vulnerable persons.

Have you ever been, or applied to be, a volunteer with a Big Brother Big Sister agency in the past?*

Which agency(ies) were you involved with?

Please list any Bigs, Littles or Parents of Littles (or other volunteers or clients associated with BBBSO) whom you know.

We will contact all vulnerable sector agencies – please provide the following information:

Agency/Organization

When did you volunteer/work with this agency/organization?

For how long did you volunteer/work?

Contact Person:

Email

Telephone

Agency/Organization

When did you volunteer/work with this agency/organization?

For how long did you volunteer/work?

Contact Person:

Email

Telephone

References

Please complete all sections fully. Incomplete reference information may cause delays in processing your application. –Note: If you are involved in a relationship of significance (married, common-law, long-term partner/ boyfriend/ girlfriend) you must use this person as a reference. * denotes that answers to these questions are mandatory (if using that specific reference). PLEASE BE SURE TO INPUT A VALID EMAIL ADDRESS FOR EACH REFERENCE. We will only contact the necessary references, therefore not all references will be contacted.

Significant Other/Partner*

Name

Relationship with you

Years Known

Language Preference*

Email*

Telephone*

I confirm that if I have a significant other at present time, I’ve provided them as the reference.

Volunteer Reference (or Employment Reference if no volunteer experience within the last 5 years)

Name

Relationship with you

Years Known (min 6 mths for Volunteer or min 1 year for Employment):

This is a:

Language Preference

Email

Telephone

I confirm that I’ve provided a Volunteer Reference or Employer Reference

Vulnerable Sector Reference

Name

Relationship with you

Years Known

Language Preference

Email

Telephone

Personal Reference*

Name

Relationship with you

Years Known (min 2 yrs):

Language Preference*

Email (N/A if none)*

Telephone (N/A if none)*

Family Reference*

Name

Relationship with you

Years Known (min 2 yrs):

Language Preference*

Email (N/A if none)*

Telephone (N/A if none)*

By entering my full name and clicking Next:*

I hereby attest that the information in this application is accurate to the best of my knowledge

Name*

Prénom Nom

Date

VOLUNTEER PERMISSION AND RELEASE AGREEMENT*

TO: Big Brothers Big Sisters of Ottawa (THE “AGENCY”) 
 
The Agency and Big Brothers Big Sisters Canada (“BBBSC”) are separate entities and this Agreement is between me and the Agency.
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 	<li>By applying to volunteer with the Agency (“Volunteer Application”) and signing this Agreement, I acknowledge, understand and accept that:</li>
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(a)  I am a legal resident of Canada and have reached the age of majority in the province or territory  in which I reside. I acknowledge and agree that if I have not reached the age of majority of the province or territory in which I reside, my parent or legal guardian will also need to sign this Agreement in order for my Volunteer Application to be considered;
(b)  There is no obligation on the Agency to accept my Volunteer Application or assign me as a volunteer into a mentoring program (a “Mentoring Program”) and the Agency may terminate my involvement in a Mentoring Program in its sole discretion and without reason;
(c)  If I am accepted as a volunteer, my involvement in a Mentoring Program is not intended to create and shall not be construed as creating either an employee–employer relationship or a contract for services that would allow me to receive a salary, compensation, payment or any benefits, monetary or otherwise; and
(d)  If I am accepted into a Mentoring Program, I understand that I will be required to enter into a confidentiality agreement with the Agency, and I agree to abide by the volunteer position description(s) and code(s) of conduct established by the Agency, including any applicable guidelines, Standards and policies.
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 	<li>Assumption of Risk, Release and Reimbursement:</li>
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I acknowledge, understand and accept that:
(a)  I am responsible for all risks associated with my involvement in a Mentoring Program including, without limitation, the risk of bodily or psychological harm or injury.
(b)  Subject to local laws, I agree not to sue the Agency, BBBSC and/or any of their member agencies in respect of any such injury or claim resulting from my participation in a Mentoring Program, my Volunteer Application, the acceptance or denial of my Volunteer Application, the Alumni Program and/or my association with the Agency or BBBSC.
(c)  I understand that I am fully responsible for any damage to my personal vehicle and/or property during my volunteer involvement in a Mentoring Program and that neither BBBSC nor the Agency insures personal vehicles or property belonging to its volunteers;
(d)  I agree to reimburse the Agency and/or BBBSC and/or any of their member agencies for any damages or losses of any kind (including but not limited to the injury of any other person and/or damage to or loss of property) that may arise in connection with my gross negligence, wilful misconduct, or failure to act in accordance with published BBSC policies and guidelines and relating to or arising in connection with my participation in a Mentoring Program or my association with the Agency or BBBSC, including payment of any and all legal expenses of the Agency, BBBSC and/or any of their member agencies.
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 	<li>Background Check. I understand that my acceptance into the Mentoring Program will be conditional on my successful completion of a background check, which may include contacting the references included in my Volunteer Application and/or a criminal record check, for the purposes of confirming my suitability for the Mentoring Program. I agree to provide all necessary consents for such background checks.</li>
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 	<li>Privacy Notice. The personal information provided by me or otherwise collected by the Agency in connection with my application will be used by the Agency for the purpose of evaluating and considering my Volunteer Application and, if accepted into a Mentoring Program, for the purpose of administering the Mentoring Program. This information may include my name, phone number, mailing address, date of birth, results of background check, and driver’s license and auto insurance information. My personal information will be maintained by the Agency on a confidential basis and will only be disclosed to the parent(s) and/or guardian(s) of a child with whom the Agency may consider “matching” me in a Mentoring Program, to representatives of a school or institution in connection with my participation in a site-based Mentoring Program, to the BBBSC as required for the purposes of accreditation reviews or legal proceedings and as otherwise required or permitted by law. In the event the Agency ceases operations, any and all information about me held by the Agency will be provided to BBBSC, another BBBSC agency selected by BBBSC, or both and will be used for the purposes set out above.</li>
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 	<li>Other Terms of this Agreement. </li>
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(a)  In entering into this Agreement, I am not relying on any oral or written representations other  than as set forth in this Agreement.
(b)  This Agreement shall be governed by and construed pursuant to the laws of the Province or  Territory in which the Agency is located.
 
(c)  In the event that any provision or term of this Agreement is held to be invalid, illegal or  unenforceable, the remaining provisions of this Agreement shall remain in full force and effect.
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 	<li>Media Consent. Any photographs or video productions taken of volunteers by agency staff at recreational events or match outings, or otherwise authorized by the Executive Director or Board of Directors, may be used by the agency for purposes of promotional material including brochures posters, newsletters, media information, advertisements, audio-visual productions and web pages, such as the Agency website and social media. Photographs or video productions may also be shared with community and school partners and Big Brothers Big Sisters of Canada for program promotion.</li>
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IMPORTANT: I acknowledge that I have read the terms of this Agreement, have been given an opportunity to obtain independent legal advice, and understand that it represents a waiver of certain of my legal rights, including my right to sue (subject to local laws). I further agree that such limits are reasonable and sign this Agreement freely, voluntarily and without duress.

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By ticking this check box:

I confirm that I agree with item #6 of Media Consent.

By entering my full name and clicking Submit:*

I hereby confirm that I have completely read, fully understand and agree with the statements outlined in the Volunteer Permission and Release Agreement.

Name*

Prénom Nom

Date

Name

Ce champ n’est utilisé qu’à des fins de validation et devrait rester inchangé.

Personal Information

Getting to Know Your Child

Vulnerable Sector Reference and Experience

Employment & Education

References

Quick Links

Mentoring Programs