Mentorship Program Application Name(Required) First Last Pronouns (ex. she/her, they/them, he/him)(Required) Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email Emergency Contact Name First Last Emergency Contact PhoneProgram AreasWe have mentor opportunities in many program areas. There is no guarantee you will be placed in your preferred program area. Please select all of the program areas you are interested in: Food Security/Kitchen Drop-in HOMES/Housing Settlement Housekeeping Select AllPlease list your top three preferred program areas (the program areas you would most like to work in): Mentorship CommitmentMentor positions involve a six-month contract, where mentors work a maximum of 10 hours a week at the centre. Mentors can apply to renew their contract, up to a total of 18 months (or 3 x six-month contracts). Are you able to commit to a six-month contract from January - June 2022? Yes No I don't know What are two goals you would like to work on during your time in the Mentorship Program?What assets, skills, or abilities do you have that would make you a good mentor?We are currently unable to provide childminding services due to the COVID-19 pandemic. If you are have children, do you have a child care plan to allow you to participate in the mentor program?If we are able to provide childminding services in the future, will you require child care during your shift time? Please list number of children and their ages:Do you have a recent (within one year) criminal record check? Yes No I don't know Do you have a recent (within one year) child abuse check? Yes No I don't know Do you have a Food Handlers certificate? Yes No I don't know AvailabilityPlease list the times you are available each day of the week to attend mentor shifts. Mondays Between 9:00 am - 4:30 pm Tuesdays Between 9:00 am - 6:30 pm Wednesdays Between 9:00 am - 4:30 pmThursdays Between 9:00 am - 6:30 pm Fridays Between 9:00 am - 4:30 pmSaturdays Between 8:00 am - 12:30 pmIf offered a Mentor position, when would you be able to start? Please attach a copy of your resume:Max. file size: 64 MB.Please attach a copy of your cover letter:Max. file size: 64 MB.
