Caldwell Friends Mentor Application
Please complete this application to the best of your ability and we will be in touch with you as soon as possible!
Contact Information
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you lived at this address? If you have not lived at the current address for two (2) years, please list your former address in this box as well!
Please list any other North Carolina Counties or states that you have previously lived in:
Email
example@example.com
Phone Number
Please enter a valid phone number.
Is there a school district you prefer your mentee to reside in? If so, please list it in the box below!
Do you have a preference for the age of the mentee you wish to serve? We serve youths aged 6-18.
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Personal Information
Please provide your race:
What is your biological sex?
Do you have another preferred gender identity?
Yes
No
If you answered yes above, please provide your preferred gender identity here. If it will not let you proceed, simply put no in the box below.
Are you?
Single
Dating
Married
Divorced
Separated
Widowed
Please provide an emergency contact's name below.
Please provide your emergency contact's cell phone number below:
Please provide your emergency contacts relation to you below:
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Let's Get to Know YOU More!
Please tell us about your hobbies, interests, favorite sports and/or activities? Essentially anything that would help us get to know you more and what would help us better match you with a mentee!
Why are you interested in serving as a mentor for Caldwell Friends?
Have you volunteered anywhere else prior to Caldwell Friends? If so, please provide the agency in which you volunteered for, a contact person and their phone/email, and your responsibilities. If you have had no prior experience, please write "no" in the box below!
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Current Employment History
If you have yet to be employed, please state that in each of the below boxes if it will not let you proceed!
Please provide your employer's name:
Please provide your title at your place of employment along with a brief description of your job duties:
Please provide the address of your place of employment:
Please provide contact information for your employer such as their number or email:
Please list previous employment if you have been at your present job for less than two (2) years, starting with the employer name. If you have had your present job for longer than two years, please indicate the length of time in the box below!
Again, this is for your previous job. Please provide your title at your place of employment along with a brief description of your job duties.
Please provide the address of your previous place of employment below. Like the other boxes, if you have been at your current job longer than two years, please indicate that or that you have yet to begin working.
Lastly, for your previous employer please provide contact information for your employer such as their number or email. Finally, if you have yet to work anywhere or have been at your present job for longer than two years, once more indicate it here! (I promise this is the last time you will have to enter that, we just want to ensure that you are able to complete the application, and the system does not flag your application)!
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Please complete the information below as it is important to your role as a mentor!
As a Caldwell Friends mentor, you will be required to transport your youth so we require certain information that you will be asked below. If you are unable to do so, please indicate that in each of the fields below and feel free to email us at chassidy.barnhardt@caldwellfriends.com where we will be happy to work out other options for you!
Do you have a valid drivers license?
Yes
No
Please provide your date of birth below
-
Month
-
Day
Year
Date
Please provide your driver's license number:
Please provide the state in which your driver's license was issued:
Please provide the expiration date of your license:
-
Month
-
Day
Year
Date
Please provide your auto insurance carrier:
Please provide the date in which your auto insurance expires:
-
Month
-
Day
Year
Date
We require a social security number in order to process a background check on our mentees. In the interest of safety, do not provide it here but instead email it to chassidy.barnhardt@caldwellfriends.com. If it will not let you continue, please type 0000 in order to resume.
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Education Information
Have you already graduated high school?
Yes
No
Please list your high school below as well as the years you attended.
Have you attended college?
Yes
No
Please list the college you attend/attended below. If you did not attend, please state no in the box below.
Please indicate the highest degree you have received. If you have only received your high school diploma, please indicate that below!
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History Information
Do you have any history of alchol or drug usage?
Yes
No
If you indicated yes above, please briefly explain the treatment you received. If you answered no, just type No into the box below.
Have you ever been convicted of a misdemeanor or a felony?
Yes
No
If you answered yes above, please briefly explain the offense and the conviction dates below. If you selected no, please also type no below!
Have you ever been convicted of a traffic violation?
Yes
No
If you answered yes above, please briefly explain the offense and the conviction dates below. If you selected no, please also type no below!
Is there any information that you would like to add regarding the information above? If no, please simply type no in the box below.
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In order to serve as a mentor, we must require three references! So you will be asked to provide that information below! Please do not include relatives and only utilize people you have known for longer than one year!
Psst: You're almost done with the application! Thank you so much for your patience so far!
Reference ONE Full Name
First Name
Last Name
Reference ONE Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reference ONE Email Address
example@example.com
Reference ONE Cell Phone Number
Please enter a valid phone number.
Relation to Reference ONE
Reference TWO Full Name
First Name
Last Name
Reference TWO Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reference TWO Email Address
example@example.com
Reference TWO Cell Phone Number
Please enter a valid phone number.
Relation to Reference TWO
Reference THREE Full Name
First Name
Last Name
Reference THREE Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reference THREE Email Address
example@example.com
Reference THREE Cell Phone Number
Please enter a valid phone number.
Relation to Reference THREE
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Signature Page
I certify that all information on the application is true to the best of my knowledge. I agree for a criminal background check to be conducted and a driver's license check to be conducted, as well. Furthermore, I authorize the agency to inquire about my previous/present volunteer and work experiences and to contact the references I listed. I understand that any false statements, withheld information or negative feedback from reference(s) will be reason(s) to disqualify me from volunteering with this agency.
Signature
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Caldwell Friends Mentor Application
Thank you for taking the time to complete this application. We will reach out to you as soon as possible and we cannot wait to have you as part of our Caldwell Friends family! If you have any questions or concerns regarding the application, please feel free to contact us via email at chassidy.barnhardt@caldwellfriends.com. Thank you again so much!
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