Placement Student Mentor Application

This Form Will Take You Roughly 20-30 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!

Student Mentor Eligibility Criteria

Before completing the application please review and complete the following checklist:(Required)

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

I am at least 18 years old.

I am currently enrolled in a post-secondary institution.

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

I understand that I will be responsible for providing a recent Vulnerable Sector Check prior to the start of my placement.

I understand that my placement offer is contingent upon the successful completion of the Mentor Application process.

I understand that BBBSPY is committed to creating an inclusive environment where all members of the community feel safe and respected. As a Placement Student and Mentor, I will actively work towards supporting this commitment.

PERSONAL INFORMATION

Name(Required)

First Last

Preferred Name (if applicable)

Gender Identity(Required)

Pronouns

Address(Required)

Street Address Address Line 2 City Province Postal Code

Phone(Required)

Email(Required)

Date of Birth(Required)

Birth Place

Your response to this question is voluntary.

Canada

Other

Language(s) Fluently Spoken(Required)

Big Brothers Big Sisters of Peel York is an equal opportunity employer and is committed to creating a working environment inclusive of the diverse population it serves. If you require any accommodations in order to have a fulfilling and successful placement opportunity, please provide details here.

VEHICLE INFORMATION

Are you a licensed driver?(Required)

Placement Students are required to have at least a G2 driver's license.

Do you have access to a vehicle?(Required)

Placement Students are required to have access to a reliable vehicle on placement days.

Yes

No

Please select your current vehicle insurance coverage(Required)

$1million

$2million

I do not have vehicle insurance

EDUCATION INFORMATION

Name of Post-Secondary Institution(Required)

Name of Program and Year of Study(Required)

Please list any other degrees, diplomas, and trainings

EMPLOYMENT INFORMATION

Are you currently employed?(Required)

Yes

No

If Yes, please list your employer

What is your current job title?

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(Required)

Personal Reference Email(Required)

Personal Reference Phone(Required)

How long have you known your Personal Reference?(Required)

In what capacity do you know your Personal Reference?(Required)

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(Required)

Vulnerable Sector or Employer Reference Email(Required)

Vulnerable Sector or Employer Reference Phone(Required)

How long have you known your Vulnerable Sector or Employer Reference?(Required)

In what capacity do you know your Vulnerable Sector or Employer Reference?(Required)

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(Required)

Family Reference Email(Required)

Family Reference Phone(Required)

How long have you known your Family Reference?(Required)

In what capacity do you know your Family Reference?(Required)

REFERENCE PAGE ATTESTATION

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.(Required)

Yes

No

Signature(Required)

BBBSPY Placement Student Mentor Application Form