Mentor Application

Mentor Application
Full Name*
Pronouns*
YesNo
Address*
City*
Postal Code*
How long have you lived in Elgin County?*
Phone Number*
Format: (000) 000-0000.
Secondary Phone
Format: (000) 000-0000.
Email Address*
example@example.com
How did you learn about the Big Brothers Big Sisters Program
YesNo
If yes, where and when?
Why do you want to become a volunteer in the program now?
Big Brothers/Big Sisters 1-1 MatchIn-School Mentoring 1-1 MatchBig Bunch Community GroupIn-School Groups (Go Girls/GameOn)Friend of the AgencyYouth of the AgencyUnsure
References

Personal Reference (someone you have known for at least 2 years)
Please provide a reference(s) if you have worked with or volunteered with a person or organization responsible for the well-being of children under the age of 18 or with vulnerable persons who, because of their age, a disability, or other circumstances are at greater risk than the general population of being harmed by a person in a position of authority or trust relative to them.
Name*
City*
Prov*
Email Address*
example@example.com
Primary Phone*
Format: (000) 000-0000.
Secondary Phone
Format: (000) 000-0000.
How long have you known this person*
In what capacity*
Vulnerable sector Reference¹ (if no volunteer or paid experienced exists in the vulnerable sector within the last five years, an employment reference is required) Name:
Name*
City*
Prov*
Email Address*
example@example.com
Primary Phone*
Format: (000) 000-0000.
Secondary Phone
Format: (000) 000-0000.
How long have you known this person*
In what capacity*
Significant Other (if no significant other exists, a family reference is required)
Name*
City*
Prov*
Email Address*
example@example.com
Primary Phone*
Format: (000) 000-0000.
Secondary Phone
Format: (000) 000-0000.
How long have you known this person*
In what capacity*
a) I consent to Big Brothers Big Sisters St. Thomas - Elgin contacting the references, in confidence, included in my Volunteer Application and I hereby waive the right to request disclosure of the personal references given about me. b)I consent to Big Brothers Big Sisters St. Thomas - Elgin collecting information from any Big Brothers Big Sisters agency with which I am, or was formerly involved, including a Big Brothers Big Sisters agency in another country with which I am, or was formerly involved.

TO THE BEST OF MY KNOWLEDGE, THE ABOVE INFORMATION IS COMPLETE AND ACCURATE. I UNDERSTAND THAT THE INFORMATION CONTAINED IN THIS APPLICATION WILL BE HELD IN STRICT CONFIDENCE AND WILL ONLY BE USED TO ASSESS MY SUITABILITY AS A VOLUNTEER EXCEPT WHERE REQUIRED BY LAW. I
UNDERSTAND THAT THIS APPLICATION BECOMES THE PROPERTY OF St. Thomas - Elgin AND SUBSEQUENTLY BIG BROTHERS BIG SISTERS OF CANADA.
Applicant Signature*
Date*

MonthDayYear
Date
Should be Empty:

Mentor Application

References