Volunteer Application

Please utilize this form to submit an application to be a volunteer in one of our program areas. To learn more about our programs, visit www.poweredbypartners.org/mentoring

"*" indicates required fields

Partners Mentoring Application

Thank you for taking the time to fill out this application! We are thrilled to get you started on the screening process to become a mentor. We realize that this application is in-depth and a bit personal, and we appreciate your willingness to share your answers. Please know that all information is kept confidential. We follow best practices in the field of mentoring, and ask all questions to ensure that a mentor applicant is a good fit to work with the youth in our program, and to help us find the best fit for each mentor. We are excited to get to know you better!

Which Partners location are you applying at?*

Which volunteer role are you applying for?*

Name*

First Last

Pronouns

Age*

Date of Birth*

Month

Day

Year

Physical Address*

Street Address Address Line 2 City State ZIP Code

Is your physical address different than your mailing address?

Yes

Mailing Address

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Preferred method(s) of communication*

Text message

Phone Call

Are you or have you been a parent or caregiver?*

Yes

Employment History

Current Employer/Company*

Employer Address*

Employer Phone Number*

Position*

How long employed?*

Supervisor*

List other employment or internships (most recent first)*

Position

How long employed?

Reason left?

Add multiple entries by clicking the plus sign.

Residence History

List the past two residences (most recent first)*

Address

City/State

How long there?

Add multiple addresses by clicking the plus sign.

How many times have you moved in the last 5 years?*

How long have you lived in Colorado?*

Criminal History:

Have you ever been involved, investigated, arrested, and/or convicted of an assault?*

Yes

If Yes, when and please explain:

Have you ever been involved, investigated, arrested, and/or convicted of a felony or any other offense?*

Yes

If Yes, when and please explain

Have you ever been involved, investigated, arrested, and/or convicted of child abuse, neglect or sexual molestation of a minor?*

Yes

If Yes, when and please explain:

Emergency Contact

Emergency Contact*

Name

Phone Number

Relationship to You

Use the plus sign to add more than one emergency contact

Health Information

Health*

Poor

Fair

Good

Excellent

Do you have any physical limitations or concerns?*

Are you taking medication on a regular basis?*

Yes

Please list your medication(s)

Do you have any known allergies?*

Yes

Please list known allergies:*

Have you ever sought counseling/therapy or treatment for any reason?*

Yes

Please explain:*

Explain your present use of alcohol or any other substances:*

Explain your past use of alcohol or any other substances:*

Driving Information

Do you have a valid Driver’s License?*

Yes

Driver License Information

State: Number

Do you have your own transportation?*

Yes

License Plate #:

Do you have access to transportation?

Yes

Please describe:

Do you have current vehicle insurance as required by this state’s law?

Yes

Vehicle Insurance

Company

Policy Number

Please describe your driving record and offenses:*

References

1) Relative (known most of life) 2) Employer/Professional 3) Friend (spouse or significant other if applicable, known at least 2 years) 4) Friend (counselor/therapist if applicable, or friend known at least 2 years)

Please list FOUR references:*

Name

Phone

Relationship

Years Known

Add more references by clicking the plus sign.

Hobbies and Interests

What attitudes and beliefs are of special importance to you?*

Please list interests, hobbies, and activities that you pursue.*

Consent*

I agree to the following statement:

I certify that all the above information is correct to my knowledge.

Consent*

I agree to the following statement:

I understand that Partners will contact the above-listed references, any other persons deemed necessary, and will complete a thorough investigation compiling information on me that includes, but is not limited to: my character, personal characteristics, mode of living, general reputation, criminal history, academic credentials, employment history, work habits, job performance, experience and reasons for termination, education, qualifications and motor vehicle driving record. I will provide Partners with proof of automobile insurance and driver’s license. I understand that misrepresentation of personal information or history at any time could result in termination or non-acceptance in the Partners Program. I understand that the Partners organization reserves the right to decline volunteers or terminate their volunteer status at any time. A decline is not meant to be a reflection of the personal character of an individual, or of our perception of their ability to volunteer in another setting. Partners’ staff accepts or declines volunteers based on all the information gathered in the screening process and for reasons of confidentiality and liability will not share this information or reasons of denial with any applicant.

Digital Signature

Please type your full name to serve as a digital signature.

Date

MM slash DD slash YYYY

Volunteer Application

Partners Mentoring Application

Employment History

Residence History

Criminal History:

Emergency Contact

Health Information

Driving Information

References

Hobbies and Interests

quick links

FORT COLLINS & LOVELAND

ESTES PARK

GREELEY

Make an Impact this National Mentoring Month