BBBSPY Mentor Application

This Form Will Take You Roughly 30-45 Minutes To Complete

The Mentor Application Form will take between 30-45 minutes to complete. In order to keep the information private and secure this application must be completed all at once and cannot be saved in stages. Please make sure you have enough time before starting the application. Thank you!

Mentor Eligibility Criteria

Before completing the application please review and complete the following checklist:*

Each box must be checked in order for your application to be considered complete.

I am at least 18 years old.

I am a resident of Peel Region, York Region or Bradford West Gwillimbury.

I understand that the time between application and program involvement could be between 3-6 months.

I understand that I am expected to commit for a minimum of one year for program involvement.

I understand the enrolment process includes a Vulnerable Sector Check, which has a cost of approximately $32 to be paid by me.

I understand that Big Brothers Big Sisters of Peel York is under no obligation to approve my application.

I understand that if I am not accepted as a Mentor, I will not be provided with a reason why.

I understand that BBBSPY is committed to creating an inclusive environment where all members of the community feel safe and respected.

As a volunteer Mentor, I will actively work towards supporting this commitment.

PERSONAL INFORMATION

Name*

First Last

Preferred Name (if applicable)

Gender Identity*

Pronouns

Street Address*

Address Line 2

City*

Province / Territory*

Postal Code*

Country*

Length of time at this address*

Phone*

Email*

Date of Birth*

Language(s) Fluently Spoken*

Are you anticipating any major changes in your life within the next 18 months?*

E.g. marital status, living arrangements, employment, children, etc.

Yes

No

If Yes, please specify.

Marital Status*

Partner/Spouse Name (if applicable)

Do you have or have you had any physical or emotional health concerns?*

Yes

No

If Yes, please describe.

Have you ever had police involvement?*

Yes

No

If Yes, please provide brief details.

Before continuing, please ensure that your references know you have applied and ask them to watch for a reference email from our Agency. Also, please ensure that the email addresses of your references are spelled correctly below. Moving to the next steps in the enrolment process is contingent upon the completion of your references.

PERSONAL REFERENCE

Examples include a friend, family friend, coworker, etc. Must have known you for at least 2 years and be 18+

Personal Reference Full Name*

Personal Reference Email*

Personal Reference Phone*

How long have you known your Personal Reference?*

In what capacity do you know your Personal Reference?*

VULNERABLE SECTOR REFERENCE

Please provide a reference from your past volunteer or work experience with an organization responsible for the well-being of vulnerable persons. This may include: children/youth under the age of 18, the elderly, and/or those with disabilities. If you have not had experience in the vulnerable sector, please provide an employment reference. Must be 18+

Vulnerable Sector or Employer Reference Full Name*

Vulnerable Sector or Employer Reference Email*

Vulnerable Sector or Employer Reference Phone*

How long have you known your Vulnerable Sector or Employer Reference?*

In what capacity do you know your Vulnerable Sector or Employer Reference?*

FAMILY REFERENCE

Examples include parent/guardian, sibling, aunt, etc. Must have known you for at least 2 years and be 18+

Family Reference Full Name*

Family Reference Email*

Family Reference Phone*

How long have you known your Family Reference?*

In what capacity do you know your Family Reference?*

SIGNIFICANT OTHER REFERENCE (IF APPLICABLE)

Any current relationship lasting 3 months or longer and/or a cohabiting relationship of any length of time must be noted here.

Significant Other Full Name

Significant Other Email

Significant Other Phone

How long have you known your Significant Other?

Please briefly describe the nature of your relationship

FINAL ATTESTATION

For the purpose of considering my Mentor Application, a) I consent to Big Brothers Big Sisters of Peel York contacting the references, in confidence, included in my Mentor Application and I hereby waive the right to request disclosure of the references given about me. b) I consent to Big Brothers Big Sisters of Peel York collecting information from any Big Brothers Big Sisters agency with which I am, or was formerly involved, including a Big Brothers Big Sisters agency in another country with which I am, or was formerly involved.

I hereby confirm that I am the individual for whom this application is being made. I further attest that the information provided here is true and complete to the best of my knowledge. I understand that the information contained in this application will be held in strict confidence and will only be used to assess my suitability as a volunteer, except where required by law. I understand that this application becomes the property of Big Brothers Big Sisters of Peel York and subsequently Big Brothers BigSisters of Canada.*

Yes

No

Signature*

Name

This field is for validation purposes and should be left unchanged.