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Men‑Tours Mentor Application

Complete this application to be considered for the Men‑Tours mentorship program. All information is kept confidential and used solely for volunteer screening.

Personal Information:

Full Name *

Date of birth *

Address *

City / State / ZIP *

Phone *

Email *

Driver’s License Number & State *

Employment & Background

Current Occupation *

Employer *

How long with current employer? *

Mentorship Interest

Why do you want to join Mentors Counte Alliance? *

Have you ever mentored youth before? If yes, please describe. *

Background & Legal Disclosure

Answer each question. A “Yes” response does not automatically disqualify you. Failure to disclose will.

Have you ever been convicted of a felony? *

Yes

Have you ever been convicted of a misdemeanor involving a child, violence, drugs, or sexual misconduct? *

Yes

Have you ever been investigated, accused, or disciplined for inappropriate conduct involving minors? *

Yes

Are you currently under investigation for any criminal charges? *

Yes

If you answered “Yes” to any question above, please explain:

References (3 non‑family, known you 3+ years)

Reference 1 – Name / Relationship / Phone / Email *

Reference 2 – Name / Relationship / Phone / Email *

Reference 3 – Name / Relationship / Phone / Email *

Authorization & Consent

I certify that the information provided is true and complete. I authorize Men‑Tours to obtain and review background checks, including but not limited to criminal records, sex‑offender registry, and reference/employment verification. I understand that false statements or omissions may result in denial or termination of volunteer service. I agree to comply with all Men‑Tours policies and child‑safety guidelines.

Type Full Name as Signature *

Date *

I agree to the Authorization & Consent above

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