Group Mentor Application

Thank you for applying to be a Group Mentor with Friends for Youth. The information that you provide will be kept confidential.

Group Mentor

First Name*

Middle Name*

Last Name*

Email*

Address*

City*


City if not listed above*

Zip Code*

State*


Mobile Phone*

Date of Birth*

Marital Status*


Spouse First Name*

Spouse Last Name*

Gender*


Sexual Orientation*


Primary Language*


Ethnicity*




Morning (8:00 AM - 12:00 PM)*


Afternoon (12:00 PM - 4:00 PM)*


Evening (4:00 PM - 8:00PM)*


Own Car*


Drivers License Number*

Drivers License State*


Preferred Age Range*


Education Level*


How Did You Hear About Us?*


Emergency Contact Name*

Emergency Contact Phone Number*

Have you ever applied to be a volunteer at Friends for Youth?*


Highest Degree Obtained*

Why are you interested in becoming a mentor?*

Present Occupation*

Employer/Company*

Employer/Company Address*

Employer/Company Phone Number*

Friends for Youth may contact your employer as a reference. If there is any reason that you would
not want us to contact your employer, please explain*

Do You Have Special Training or skills?*

List 4 references including 1 relative, 1 coworker, and 2 friends you have known for at least 2 years*

Family Member & Relationship*
Family Member Contact Number*
Professional Reference Name & Relationship*

Professional Reference Contact Number*

Personal Reference Name & Relationship*

Personal Reference Contact Number*

4th Reference & Relationship*
4th Reference Contact Number*
Do you have any reasonable expectation of any future change in your family status,
occupation, or residence? If yes, please explain*


Have you ever been arrested, investigated, or charged with any crime?*


If yes, please explain. Include offense date and action if applicable*:

Driving Record (Infractions such as DUI or speeding and Dates)*:

What are values and beliefs that are important to you?*

How do you feel these relate to working with young people?*

Have you had any experience working with children (volunteer, paid, etc.)? Please explain*:

Friends for Youth, Inc. does not discriminate against individuals on the basis of race, color, national or ethnic origin, sex, age (40 and over), disability, religion, veteran status, sexual orientation, or gender identity. I hereby apply for membership as a volunteer in Friends for Youth, Inc. I understand that Friends for Youth, Inc. will interview me about my background, motivation, expectations, and other personal qualities that might have a bearing on whether I would be an appropriate volunteer. I agree to supply Friends for Youth, Inc. with a copy of my driving record from the DMV and with proof of California automobile insurance. I further agree to submit my information to Friends for Youth, Inc. so that they can conduct a background check, which may include state- and federal-level fingerprint-based searches, the Sexual Offender Registry, and other pertinent Internet searches. I understand that Friends for Youth, Inc. will review references and will investigate any and all facts concerning my qualifications for becoming a volunteer. I certify that all of the information provided by me in this application is complete, true, and accurate. I acknowledge that omission or falsification of information will be cause for non-acceptance or immediate dismissal at any time during the period of my placement.I understand that the agency has to take the best interests of the children into consideration first. Further, I understand that (1) I am not obligated, if called upon, to perform the volunteer services applied for, and (2) the agency is not obligated to assign, or to actively seek to assign me to a volunteer position.I understand that the statements I make to the staff of the agency will be held confidential within the agency, unless disclosure is required by law. Specifically, I understand that incidents of child abuse or molestation, past or present or threat of harm to oneself or others are issues that must be reported to proper authorities.I understand that certain information about me will be discussed with the parent/guardian of the child with whom I am matched. If there are things about me that I do not want repeated, it is my responsibility to discuss this with the Friends for Youth staff.I agree to keep information discussed with me regarding a potential match confidential. I will not discuss this information with any person other than the assigned professional staff of Friends for Youth, Inc.I understand that my application will not be considered unless it is complete and signed, and until the required supplemental information is submitted and completed.I agree to notify Friends for Youth, Inc. immediately of any changes in the information provided in the application process, including, but not limited to: legal status, driving record, job change, address change, telephone, name change, or marital status. I also agree to maintain automobile insurance during my tenure with Friends for Youth, Inc. This application and any additional information gathered will remain the property of Friends for Youth, Inc.
Yes, I authorize Friends for Youth, Inc. to use and release any general information and/or photographs acquired by the agency in the context of my association with them for publicity or promotional purposes.