Pathways to Employment
VOLUNTEER MENTOR FORM
 
Thank you for your interest in becoming a Volunteer Mentor. This application form will give us an understanding of the experiences and qualities you have that may make you suitable to be a Mentor for a Pathways to Employment Client.
 
Full Name: Address:
Contact telephone number(s):
Daytime: Evening:
e-mail address
Work experience:
Job title and company (if currently working)
Please give details of your employment experiences:-
Please describe any interests/hobbies/sports/voluntary work you may be involved with which may be helpful in matching you with a young person:
Please outline your reasons for wanting to be a Mentor:
 
How much time are you able to commit as a volunteer mentor?
Hours per week = or hours per month=
Suitable times: Morning Afternoon Evening
Preferred days:
Do you have any special needs which we should know about in order to ensure you have equal access to the mentoring process - for example, disability access?

You will understand that the young adults who may benefit from your help as a Mentor may in some way vulnerable. In recruiting Volunteer Mentors, we have an obligation to protect both them and you. For this reason, we ask you to supply two referees. One reference should be from someone who can comment on your employment experiences and the other from a person who can comment on your personal qualities.

Neither should be a member of your family. Please enter their names and contact details in the space provided below so that we can get in touch with them:
Referee 1 (employment) Referee 2 (personal)
Name Name
Address Address
Postcode Postcode
Telephone Telephone
 
Again in the interests of protecting potentially vulnerable young people, I should be grateful if you would kindly complete Sections A or B, below, which covers possible criminal record provision. Please note that a criminal record will not necessarily prevent a person from becoming a Volunteer Mentor.
Declaration
A) I declare that I have no criminal record.
OR
B) I declare that detailed below are full details of my criminal record