Mentor Application Form

Mentor Application Form

Thank you for your interest in becoming a mentor. This mentoring programme aims to inspire children in care by connecting them with positive role models from a wide range of professions. While the programme celebrates Muslim professionals to help address the underrepresentation experienced by many Muslim children in care, these group mentoring sessions are open to all children in care, regardless of their faith or background. These questions are asked as part of our safeguarding responsibilities. A previous investigation does not automatically prevent someone from becoming a mentor; however, we have a responsibility to assess any information that may impact the safety and wellbeing of children and young people involved in the programme. Please complete this form in full. Completion of this form does not guarantee approval. All applications are subject to safeguarding and suitability checks.
Personal Details
Full Name

First NameLast Name
Preferred Name
Date of Birth

MonthDayYear
Date
Email Address
example@example.com
Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Town/City
County
Postcode
LinkedIn Profile
Professional Background
Professional Website
Current Job Title
Current Employer
Industry / Sector
How many years have you worked in this profession?
Please briefly describe your career journey
Mentoring Proposal and Availability
What profession or topic would you like to deliver a mentoring session on?
What would children gain from your session?
Please provide a brief outline of your proposed 2-hour session.
Please note: We cannot guarantee the ages of participants attending your session. Please ensure your content and language are suitable for a mixed-age audience. What age group would you feel comfortable mentoring?
Which days are you generally available?
Preferred times
How often would you be willing to deliver a mentoring session?
Experience and DBS
Have you previously worked with children or young people?
Please tell us about your experience.
Have you delivered presentations or training before?
If yes, please describe.
Please note: You do not need to hold a current Enhanced DBS certificate to apply. Do you currently hold an Enhanced DBS Certificate?
Referee Details
Reference Name

First NameMiddle NameLast Name
Job Title (Referee)
Organisation/Company (Referee)
Relationship to you
Referee Email Address
example@example.com
Permission to contact your referee

I give permission for the organisation to contact this referee
Referee Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Disclosure and Safeguarding Declarations
Have you ever been the subject of a police investigation, criminal investigation, or criminal proceedings?
If yes, please provide further details
Have you ever been the subject of a Children’s Social Care, safeguarding, or welfare investigation where concerns were raised about your suitability to work with children or young people?
If yes, please provide further details
Are you currently subject to any ongoing police, social care, safeguarding, professional regulatory, or disciplinary investigation?
If yes, please provide further details
I understand that the information I have provided may be verified and that misleading or false information may result in my application being withdrawn or future volunteering opportunities being affected.
I confirm that I will follow the organisation's safeguarding procedures and report any concerns about a child or young person promptly through the appropriate channels.
I agree to act in accordance with the organisation's code of conduct, values, and behaviour expectations at all times while mentoring.
I understand that my application may be subject to further safeguarding checks and reference verification where appropriate.
I confirm that the information provided in this application is complete and accurate to the best of my knowledge.
I consent to the organisation keeping and processing my information for recruitment, safeguarding, and mentoring administration purposes.
I understand that if appointed, I must notify the organisation of any relevant changes to my circumstances that may affect my suitability to mentor children or young people.
I confirm that I have read and understood the safeguarding guidance and commit to following it throughout my involvement with the organisation.
Code of Conduct
Please confirm the following:
Additional Information
Is there anything else you would like us to know about you or your experience?
Should be Empty:

Mentor Application Form

Personal Details

Professional Background

Mentoring Proposal and Availability

Experience and DBS

Referee Details

Disclosure and Safeguarding Declarations

Code of Conduct

Additional Information