MENTOR APPLICATION Thank you for your interest in SAMS! We will process your application once completed and will invite you to our orientation and training event. All volunteers will have to complete an Advanced DBS check before starting to mentor. We will then contact you with further details for the orientation and training day if you have been successful. PLEASE NOTE ALL FIELDS SHOULD BE ANSWERED, IF IT DOES NOT APPLY, PUT N/A. CONTACT INFORMATION Name: Title First Last Address: Line1 Line2 City County Postcode Email Phone Numbers Mobile Home What is your preference to contact you? EmailHomeMobile PERSONAL INFORMATION Date of Birth: Day Month Year Are you adopted? YesNo Have you been through the foster care system? YesNo If you answered yes to either of those two questions, would you be interested in mentoring a young person in Foster Care or who is in the process of being adopted? YesNo EQUAL OPPORTUNITIES MONITORING SAMS aims to represent the diverse society we live in and is a committed equal opportunity organisation. We wish to ensure that all employees, volunteers, service users and other people we come into contact with are treated fairly and are not subjected to unfair or unlawful discrimination. We welcome volunteer applications from all sectors of the community. In order to help us ensure that we are reach diversity standards, it would be helpful if you could provide answers to the questions below. How do you identify yourself, including, but not limited to, religious, ethnic heritage, gender and sexual orientation? Do you consider yourself to have a disability? If so please state below. EMPLOYMENT INFORMATION (if applicable) Employer Title/Position Held Work Address Line1 Line2 City County Postcode Work Email Work Number Supervisor’s/Managers name Years at current employer Previous employer (if less than three years in current position) Line1 Line2 City County Postcode Years at current employer Does your current employer promote volunteer activities? If yes please explain. Please indicate if you would be willing to approach your employer about any of the following: Mentoring OpportunitiesOther In-Kind Donations/ServicesSponsorship EDUCATION AND TRAINING School attended College Attended University Attended Other Education or Special Training Do you speak any languages other than English? YesNo If so, please indicate the language and level of reading, written and oral proficiency. Language 1 (written) Proficientable to communicatebasic (speech) Proficientable to communicatebasic Language 2 (written) Proficientable to communicatebasic (speech) Proficientable to communicatebasic APPLICATION QUESTIONS Your responses to the following questions will help us determine whether you are a good fit for the SAMS programme and will help us to match you with a mentee. Do you have any experience volunteering or working with young people? If so, please specify. What qualities, skills or other attributes do you feel you have that would benefit young people? What do you think will be the most challenging thing about being a mentor? What do you hope to gain from becoming a mentor? Do you have any disabilities that require support to be fully involved in the programme? YesNo If so please specify How did you hear about SAMS? VOLUNTEER EXPERIENCE Please let us know of any prior volunteering experience, the activities carried out and for how long and the volunteer organisation. BACKGROUND SCREENING SAMS works with children, and young people. We therefore are required to screen our volunteers. Pease be aware that we will carry out an Advanced DBS check before you can take up volunteering. SAMS operates an ex-offenders recruitment policy in line with the Rehabilitation of Offenders Act, 1974 (ROA), to ensure that screened applicants are not discriminated against when applying for jobs or taking up volunteering opportunities. Having a criminal history does not prevent an individual from mentoring, however if it is not truthfully disclosed he/she will be considered ineligible to mentor. Have you ever been charged for any crime? YesNo If yes please supply details. REFERENCES Please list three references that you have known for at least one year. One of these reference should be a supervisor or direct line manager, as applicable. Relatives or family members can not be used as references. Please provide details of the addresses and contact details. References will be contacted by phone and email. The information provided to us by your references will remain strictly confidential. References are required. REFERENCE 1 Name Relationship Phone Address Email Years known REFERENCE 2 Name Relationship Phone Address Email Years known REFERENCE 3 Name Relationship Phone Address Email Years known I understand SAMS reserves the right to refuse any volunteer applicant and suspend or terminate any volunteer at any time if it is discovered that they made false statements during the application process or at any time during their volunteering. I have completed the application accurately and truthfully. Please tick Many thanks for completing the application and your interest in volunteering with SAMS. We will contact you once we have processed your application.