Download Report

Mentor Application
Dear Potential Mentor,
There are many different reasons why people mentor. Some are interested in working with youth on a
professional basis, while others may need credits towards school courses. Retired individuals may choose to
mentor due to their wealth of knowledge about world affairs. Whatever the reason it is that brings you into
the doors of our organization, we appreciate the time you have taken to make a difference in the lives of the
youth we serve.
Please read the following information and fill out the entire packet. All information will be kept private.
North Star Youth Services, Inc. prides itself on member safety. All mentors need to be screened and
fingerprinted. Each mentor should agree to the terms by which our policies and procedures are
implemented. If for any reason the mentor does not meet any of the following criteria he or she can be asked
to leave.
We at North Star Youth Services, Inc. look forward to working with you on a regular basis. If you have
questions while mentoring, please ask the executive director. We hope your mentor experience brings you
back regularly to help our youth become productive members of our community.
Sincerely,
Lorinda Trujillo,
Executive Director
North Star Youth Services, Inc.
Mission Statement of North Star Youth Services, Inc.
Empower youth to create a positive foundation for their future by discovering their direction and power to
change their life. Establish a safe gathering environment offering emotional, physical, and academic support
to all youth in our community.
Vision Statement
North Star will assist our youth in discovering their purpose and value in life.
Being on time/Showing up:
Dress appropriately
No low cut shirts
No short skirts
No sagging pants
No bad language
No gang related attire
Not showing up:
If you are going to be absent, let the director know in advance.
If you are going to be late, let the director know as soon as possible.
Signing in/out:
Remember to sign-in and sign-out every day on the mentor sign-in sheet. This is how we keep track of your
hours for reporting purposes.
Discipline:
If there is a problem with a member please allow staff to discipline the member. Write down all details in
order to give staff proper information.
Injuries:
All injuries need to be documented in an injury report.
First aide is to be given by staff.
Drug & Alcohol Free Zone:
If you have been drinking alcohol or smell of marijuana you will be asked to leave immediately and asked not
to return. You are a role model for these youth, so please act accordingly.
All mentors regardless of age are required to undergo a background check as well as a live scan
fingerprinting. Our organization gets mentors from many different sources. In order to work with our
members, our mentors must reach the same standards as our employees. Our background check policy
directly pertains to our mentors. If a mentor does not meet the criteria required of the background check
policy, he/she may not mentor at North Star Youth Services, Inc.
The background check policy which pertains to all mentors is as follows:
Background checks will be conducted on all mentors prior to service and updated every 24 months.
Background checks are a two step process.
There will be an online check which will consist of the following:
•
A Social Security number trace;
•
A national criminal record search;
•
A national sex offender registry search;
•
A county criminal record search.
This check will come back within 24 hours. Mentors may start working, once cleared at this point.
There will also be a LIVESCAN requirement. All mentors will be informed that the Department of
Justice will inform North Star Youth Services, Inc. of any arrest during the mentor’s association with the
organization.
It is the policy of this organization to refuse a mentor working with members whose background check
reveals the following barrier crimes:
•
All crimes against children, including child pornography, child molestation, child abuse,
abandonment, child neglect, enticing a child into a motor vehicle, structure or isolated area
and endangering the welfare of a child
•
Crimes involving sexual assault, rape, criminal sexual contact or lewdness
•
Murder, manslaughter or homicide
•
Stalking, kidnapping and related offenses involving restraint, imprisonment, or criminal
coercion
•
Crimes involving possession of or an assault with a weapon or an assault that results in bodily
harm
•
Sales or possession of controlled substances
•
Terrorist threats
•
Cruelty to animals
•
Any attempt or conspiracy to commit any of the crimes listed above
If the potential mentor would like to appeal this decision, the entire application will be brought before the
Board of Directors at a scheduled monthly board meeting. The decision of the Board of Directors is
final.
Mentors are under the same obligation as a paid employee. Mentors are required to adhere to a specific
set and mutually agreed upon schedule. If they are unable to fulfill their particular shift, they are to phone
the director, or their alternative supervisor, immediately. Each mentor is to follow the direction of director,
or alternative supervisor.
All mentors are to fill out an application, which will be kept in a mentor binder on site. Each mentor will sign
in when they get to the program, and sign out upon completion of their mentor day. Sign-in and out sheets
can be found in the mentor binder as well. Mentors are to wear proper attire, when working with members.
Parents/Guardians who wish to mentor at the North Star Youth Services, Inc. with members are subject
to the same standards of any other mentor.
If a past employee wishes to mentor at the North Star Youth Services Inc., they must have a mentor
application on file. They must go through the same process that every other mentor goes through. All
mentor paperwork will be kept in a locked file cabinet at the site where they are mentoring.
Note: North Star Youth Services, Inc. will not discriminate against any person on the basis of race, creed,
religion, color, national origin, marital status, gender, sexual orientation or disability.
Mentor Application
PLEASE PRINT
Name
Date
Address
City
Home Phone
Work Phone
Email Address
Date of Birth
Employer
Occupation
St
Zip
Work Address
City
St
Zip
Have you ever been convicted of or plead guilty to any crime(s): Yes [ ] No [ ]
If yes, describe each in full:
Have you ever been refused participation in any other youth program? Yes [ ] No [ ]
If yes, explain:
Do you prefer to be matched with (check one)
Write a brief statement on why you wish to be a mentor
Male
Female
No Preference
Describe special interests or hobbies that may be helpful in matching you with a youth (e.g. cooking, crafts,
career interests, sports, computers, language, music etc.).
Please provide three personal references (other than family members):
(1)Name
Phone
Address
(2)Name
Phone
City
St
Zip
City
St
Zip
City
St
Zip
Address
(3)Name
Phone
Address
As a condition of volunteering, I give permission for North Star Youth Services, Inc. to conduct a
background check on me, which may include a review of sex offender registries, child abuse and criminal
history records. I understand that, if appointed, my position is conditional upon North Star Youth
Services, Inc. receiving no inappropriate information on my background. I hereby release and agree to hold
harmless from liability North Star Youth Services, Inc., the officers, employees, mentors, and volunteers
thereof, or any other person or organization that may provide such information. I also understand that
regardless of previous appointments, North Star Youth Services, Inc. is not obligated to appoint me to a
mentor position. In addition, I understand that if given a mentor position, I will be expected to observe the
mentor expectations and code of conduct during all my service hours.
Applicant Signature
Date
Applicant Name (please print clearly)