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Firm Foundation Mentoring
Mentor Application
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* Indicates required question
First and Last Name
*
Your answer
Street Address City, State and Zip code
*
Your answer
Phone number
*
Your answer
Alternate Phone
Your answer
e-mail
*
Your answer
Best time to contact?
morning
afternoon
evening
No Preference
please check all that apply
morning
afternoon
evening
No Preference
please check all that apply
Preferred Method of contact (check all that apply)
Phone
Text
email
Marital Status
Choose
Married
Widowed
Divorced
Separated
Single
Background Checks are mandatory when working with children. Are you willing to submit to a background check? (Cost is $10)
*
Yes
No
Other:
Required
Have you ever been arrested or convicted of a crime?
*
Yes
No
Required
If yes,
Misdemeanor
Felony
Other:
If yes, what is the nature of offense?
Your answer
Number of convictions?
Your answer
Date of most recent conviction?
MM
/
DD
/
YYYY
References
List below three persons who can testify to your character and abilities. References may include employers, coaches, teachers, volunteer leaders, coworkers, mentors, clergy, etc.
Reference 1- include first and last name, contact number, e-mail address, how you know them, and length of time you have known them.
*
Your answer
Reference 2- include first and last name, contact number, e-mail address, how you know them, and length of time you have known them.
*
Your answer
Reference 3- include first and last name, contact number, e-mail address, how you know them, and length of time you have known them.
*
Your answer
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