Mentor Volunteer Application

Personal Information

Date(Required)

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City Province Postal Code

Phone(Required)

Email Address(Required)

Enter Email Confirm Email

Birth Date(Required)

Work/Volunteer Experience

1. Name of Employer or Organization(Required)

Address

Street Address Address Line 2 City Province Postal Code

Last Position Held(Required)

Name of Supervisor(Required)

Date of Employment(Required)

Reason for Leaving(Required)

List of jobs, duties, skills used(Required)

2. Name of Employer or Organization

Address

Street Address Address Line 2 City Province Postal Code

Last Position Held

Name of Supervisor

Date of Employment

Reason for Leaving

List of jobs, duties, skills used

References: work or volunteer related references

1. Reference Name(Required)

Relationship(Required)

Phone(Required)

Email(Required)

2. Reference Name

Relationship

Phone

3. Reference Name

Relationship

Phone

Availability

Peer Mentor: We require Peer Mentors to commit to orientation & ongoing training sessions as well as to a 1 hour shift per week for a minimum of a 6 month term. What is your availability?(Required)

Special Skills or Qualifications

Summarize any special skills or qualifications you have from work or volunteer experiences or through other activities including hobbies or sports.(Required)

Why do you want to volunteer for the Peer Power Program?(Required)

Emergency Contact

Name(Required)

Relationship(Required)

Phone(Required)

Cell Phone(Required)

Agreement and Consent

By submitting this application, I affirm that the facts set forth in it are true and complete to the best of my knowledge. I understand that submitting my application does not guarantee my acceptance and I agree to participate in further screening to assist Family Services of Central Alberta in determining my suitability for any volunteer position. I understand that if I am accepted as a volunteer, any false statements, omission ro other misrepresentations made by me on this application may result in my immediate dismissal.

Date(Required)

Name(Required)

CAPTCHA

Mentor Volunteer Application