Teacher Candidate Mentor Application BBBSPY Teacher Candidate Mentor Application Form (York U Faculty of Ed) Step 1 of 6 16% This Form Will Take You Roughly 20-30 Minutes To CompleteIn 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 CriteriaBefore 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 the Faculty of Education at York University I understand that I am expected to commit for a minimum of one school 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. Post-Secondary Student Mentor ApplicationPlease note that the information provided in this application will be held strictly confidential. PLEASE ENSURE THE APPLICATION IS COMPLETED IN FULL.How did you hear about our agency?(Required)Brochure/PosterBusiness/CorporatePost-Secondary PresentationFormerly a BigFormerly a LittleReferred by a FriendInformation BoothEventRadioRoad SignSocial MediaNewspaperTelevisionWebsiteWord of MouthAlways KnownPlease select the program you have been enrolled in:(Required) In-School Mentoring+ BCAC In-School Mentoring+ (open to members of the Black Community) Big Possibilities Conversation Club Teen Mentoring School-Based Group Mentoring PERSONAL INFORMATIONName(Required) First Last Preferred Name (if applicable) Gender Identity(Required) Pronouns Street Address(Required) Address Line 2 City(Required) Province / Territory(Required)ONABBCMBNBNLNTNSNUPEQCSKYTPostal Code(Required) Country(Required) Phone(Required)Email(Required) Date of Birth(Required) MM slash DD slash YYYY Birth PlaceYour 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 INFORMATIONAre you a licensed driver?(Required) No, I do not have a valid driver’s license Yes, I have a G1 license Yes, I have a G2 license or above Do you have access to a vehicle on placement days?(Required) Yes No Please select your current vehicle insurance coverage(Required) $1million $2million I do not have vehicle insurance EDUCATION INFORMATIONProgram of Study(Required) Year of Study(Required)Please enter a number from 1 to 5.Please list any other degrees, diplomas, and trainingsPlease upload a clear copy of your current valid student ID(Required)If you do not yet have a student card, please upload a copy of another valid photo identification. Drop files here or Select files Max. file size: 100 MB. EMPLOYMENT INFORMATIONAre you currently employed?(Required) Yes No If Yes, please list your employer What is your current job title? RELEVANT EXPERIENCEHave you had any volunteer or work experience with children and youth?(Required) Yes No If Yes, please list and describe this experience including the name of the organization(s), the title of your role, what it involved and when it occurred.Have you ever been, or applied to be, a volunteer or Placement Student with a Big Brothers Big Sisters agency in the past?(Required) Yes No AVAILABILITYPlease provide details on your availability hereAPPLICATION ATTESTATIONI 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) 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 REFERENCEExamples 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 REFERENCEPlease 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 REFERENCEExamples 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) 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 PhoneHow long have you known your Significant Other? Please briefly describe the nature of your relationship REFERENCE PAGE ATTESTATIONI 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)CommentsThis field is for validation purposes and should be left unchanged. Facebook Twitter Google+ LinkedIn