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Mentor Application
Mentor Application
First Name
Last Name
Address
City
State/Province
Zip/Postal Code
Email Address
Phone
Date
Over 18 years of age
YES
NO
Preferred contact mode (X preference)?
Email
Cell Phone
Text Message
Fluent Language
English
French
Other:
Please briefly describe why you would like to mentor:
Employment History
Current Occupation
Current Employer
Date: _ to present
Business Phone
Ext.
City
Province
Postal Code
Occupation
Employer
Date
from
to
City
Province
Skil Sets Used
Please provide one personal and one professional reference (does not include family members)
Personal
Name
Phone
and/or Email
Relationship
City
Province
Postal
Professional
Name
Phone
and/or Email
Relationship
City
Province
Postal
Personal Interests/Other:
Please check your preferred meeting times.
Morning
Mon
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Sat
Sun
Afternoon
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Wed
Thurs
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Sun
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*NOTE: You are required to submit a police record check AND a vulnerable sector check. Please attach a copy to this application.
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