Zoho Forms

Title

Name *

First Last

Preferred Name

Ethnicity *

Mobile Number *

Email *

Address *

Street Address Suburb City Post Code

Country

Information for Police Vetting Purposes

Date of Birth *

dd/MM/yyyy

City of Birth *

Nationality *

e.g. Your home country as stated on your passport

NZ Driver's License # *

Note: You must have a valid NZ driver's license to be a mentor with BIA.

License Type *

I hereby consent to the disclosure by the New Zealand Police of any information they may have pursuant to this application to Brothers in Arms and its community partners. I understand that any record of criminal conviction I might have will automatically be concealed if I meet the eligibility criteria stipulated in Section 7 of the Criminal Records (Clean Slate) Act 2004.

I agree *

REFERENCES

References are an important part of this application. Please provide all that may be applicable.

Referee 1 - Personal

Must NOT be a relative.

Referee 1 *

First Last

Referee 1 Phone *

Referee 1 Email *

Referee 2 - Personal

Must NOT be a relative

Referee 2 *

First Last

Referee 2 Phone *

Referee 2 Email *

Referee 3 - Employer

Most recent employer.

Referee 3 Name *

First Last

Referee 3 Phone *

Referee 3 Email *

Referee 4 - Partner

If applicable

Referee 4 Name

First Last

Referee 4 Phone

Referee 4 Email

Emergency Contact

Name *

First Last

Phone Number *

Email *

Address

Street Address Address Line 2 Suburb City Post Code

Country

Your Profile

Thank you for your interest in volunteer mentoring. Mentoring is a highly relational endeavour, so we want to establish a profile so that if your application is successful, we can make a great match between you and a young person.

How long have you lived at your current address and how long do you expect to live there? *

If there are any restrictions to your residence in NZ please give brief details

Are there others that live with you? If so, how are they related to you? *

Do you speak any languages other than English? If so, please specify. *

What are your hobbies? What do you like to do in your spare time? *

What motivated you to apply to be a mentor? *

Do you have any previous experience with young people? *

e.g. volunteering experience, work with young people, personal connections with young people

Do you have (or have you had) any mental, physical or chronic illnesses or conditions that may limit your ability to volunteer as a mentor? *

Please describe your faith and/or values, and how they impact the way that you live. *

What time commitments do you currently have? Are these likely to increase in the next year? *

e.g. volunteering, employment, family, etc.

What is a goal you have for the coming year? *

What is a dream or goal you have for the future? *

IMPORTANT: Is there anything else you think we should know that could impact your application to be a volunteer mentor? Anything else you would like us to be aware of?

Statement of Commitment

Research shows that that failed mentoring relationships (lasting < 6 months) often result in more harm to a young person's development than if no mentoring relationship had begun. Therefore, honouring this commitment is very important.

I have made Brothers in Arms aware of things that may be pertinent to my potential role as a mentor. I understand that by submitting this application I am not guaranteed acceptance as a volunteer with Brothers in Arms or its community partners.

If accepted, I will commit to meeting weekly with a young person for a minimum of 1 year. I understand that dishonoured commitments are detrimental to young people's lives.

Mentor Application Form

Information for Police Vetting Purposes

REFERENCES

Referee 1 - Personal

Referee 2 - Personal

Referee 3 - Employer

Referee 4 - Partner

Emergency Contact

Your Profile

Statement of Commitment

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