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  • ASC Mentor Application & Background Check Agreement

  • Marital Status*
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • **If at your current address less than 7 years, enter addresses for the last 7 years below: (Mo/Yr.) (Mo/Yr.)**
  • Employment Status*
  • Are you CPR Certified?*
  • First Aid Certified?*

  • In your opinion, what are 3 of your strongest character traits?

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  • Do you consider yourself to be a person of faith?*

  • In the past 12 months, have you struggled with any of the following?

  • Illegal Drugs*
  • Abusing Prescription Medication*
  • Excessive Alcohol*
  • Depression*
  • Pornography*
  • Have you ever been treated for alcohol/substance abuse?*
  • Have you ever been accused of any type of abuse (child, domestic, etc.?)*
  • Have you ever been investigated by Child Protective Services?*
  • Have you ever been arrested, convicted of, or pleaded guilty or "no contest" to a criminal act?*

  • ASC Fraternization policy

    • ASC prohibits romantic relationships between any reporting volunteer/mentor with any ASC family member. This includes any mentor's children dating an ASC child.

    Zero tolerance policy on the above. You will be dismissed immediately if the above occurs.

  • Please provide us with two (2) contacts for character reference:

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
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  • ASC BACKGROUND CHECKS OF ALL MENTORS THROUGH VALIANT

  • *If you have any questions on the following, please call our office at (615) 220-1600.

    • I give A Soldiers Child Foundation (ASC) permission to check my references.
    • I understand that in submitting this application, I also consent to a formal background check through a third-party company (Valiant) to which ASC will refer me via the email address I have provided.
    • I understand that by submitting this application, I am willfully consenting to this background check process.
    • I understand that the personal information learned from such background checks will be held confidential by ASC staff according to their strict Privacy Policy.
    • I also release ASC and their provider of background information from liability claims or suits with respect to the information obtained during this check. Should my application be accepted, I agree to refrain from illegal or unethical activities in the performance of services on behalf of ASC.


    YES, I am submitting this application with the consent to conduct a background check.
  • Date:*
     - -
    2 digit month, 2 digit day, 4 digit year
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  • Should be Empty: