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 understand I must return all of the following completed items along with this application, and that any incomplete information will result in the delay of my application being processed:
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.
Tutor/mentor and Life Book volunteers only: 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.