PART I: Personal Information
PART II: Employment HistoryPlease provide employment information for the past five years, with most recent position first. If more space is needed, use an extra sheet of paper.
PART III: Personal ReferencesPlease list the names, addresses, and phone numbers of three people you would like to use as character references (only people you have known for at least a year). Include one relative. Any information Arizonans For Children (AFC) gathers from these references will be held as confidential and not released to you, the applicant.
PART IV: Program-Specific InformationTutor/mentor and Life Book volunteers:
Please list all members of your household (Tutor/mentor and Life Book volunteers only):
Please rate your comfort level in working with the following age groups (Tutor/mentor and Life Book volunteers only):1 = I prefer working with this age group 2 = I feel pretty comfortable working with this age group 3 = I feel uncomfortable with this age group
Please read this carefully before signing:
Please initial each of the following:
I agree to follow all AFC program guidelines and understand that any violation will result in suspension and/or termination.
I understand that AFC is not obligated to provide a reason for their decision in accepting or rejecting me as a mentor.
I have read and understand the program's rules, regulations, and responsibilities for becoming a mentor. If selected, I will follow the policies and procedures of the program and be a dedicated, trustworthy mentor. I agree to the time commitment of 2-3 hours/week for one year.
By signing below, I attest to the truthfulness of all information listed on this application and agree to all the above terms and conditions.
Please mail or fax completed form to Arizonans for Children (AFC).
I, , understand it will be necessary for AFC to conduct a background check regarding my driving record, criminal history, personal references, and employment.
I authorize AFC to obtain any needed information regarding my driving record, legal/criminal history, character references, and employment from any state or federal agency, my employer, and personal references for the purposes of participating in AFC programs. Further, I provide permission for AFC to conduct the same investigation of my background in previous states in which I have resided.
Further, if I am applying for a program involving a one-on-one match, I understand that information about myself will be anonymously (without my name) shared with a prospective foster youth and his/her parent(s)/guardian(s) to aid in determining a suitable match. Once a match is determined, my identity and any other information known about me may be shared with the youth and parent/guardian to ensure a safe and successful mentor relationship.
Please list any other cities, states, and dates of residency during the past 10 years.