Mentorship Service Application

Employment/Volunteer Experience History Information
Employment/Volunteer Service History: Current and previous employer.
Most Recent Employer Name

First NameLast Name
City, State
Position Held
Start Date

MonthDayYear
Date Finished

MonthDayYear
Employer phone

Area CodePhone Number
Supervisor name

First NameLast Name
Describe your duties:
Reason for leaving
NEXT EXPERIENCE
Employer Name

First NameLast Name
City, State
Position Held
Start Date

MonthDayYear
Date Finished

MonthDayYear
Employer phone

Area CodePhone Number
Supervisor name

First NameLast Name
Describe your duties:
Reason for leaving
Personal References (Include complete names, addresses, telephone numbers, and relationship for three people you authorize us to contact who would evaluate your qualifications as a volunteer). Do not include more than one family member.
Reference 1
Reference 2
Reference 3

I understand and agree that, if selected, my service is "at will" and is for a period of 12 months and may, regardless of circumstances, be terminated at any time without prior notice by Artesian Schools, Inc./DeltaCorps.

I acknowledge that as a condition of my service, I will be required to agree to the terms of the program. Failure to sign this agreement shall result in revocation of my offer of service.
I ACCEPTI DO NOT ACCEPT
I hereby consent to permit Artesian Schools, Inc. to conduct a search of state criminal history information and a finger-print based FBI check for selection and compliance purposes. I understand that selection into the program is contingent upon successful clearance of these checks and a search of the National Sex Offender Public website. I understand that if I have been convicted of murder of if I am required to be registered as a sex offender I am ineligible to work or serve in this position.
I ACCEPTI DO NOT ACCEPT
Should be Empty:

Smooth Transitions Mentor Application