Workplace Connections Application Form

Contact details

Full name: *

Address: *

City: *

Postal code: *

Home phone:

Cell phone:

Email address:

Motivations and experience

How did you hear about Workplace Connections?: *

Why would you like to volunteer as a mentor?: *

Please describe any previous mentoring experience: *

Have you ever worked or volunteered with MOSAIC before? If so, please tell us when, where and in what capacity: *

Please describe any other relevant volunteer experience: *

Industry experience

What is your profession/occupation?: *

Please describe your current role at work: *

Please describe your skills-set: *

Tell us about yourself

Gender: *

Age: *

Country of origin: *

Length of time in Canada: *

First language: *

Other languages:

References

Please provide two professional references. Applicants who cannot provide this information may be excluded from volunteering as a mentor. We will contact your references and may also contact other people to determine your suitability for the volunteer position.

Reference 1

Full name: *

Relationship to you: *

Length of relationship: *

Phone number: *

Email address:

Reference 2

Full name: *

Relationship to you: *

Length of relationship: *

Phone number: *

Email address:

Emergency contact

Full name: *

Relationship to you: *

Phone number: *

Police record check

You will be required to undergo a police record check if your partner has children or belongs to a vulnerable population group. MOSAIC will reimburse you if there is a cost involved.

Are you willing to undergo a police record check if required and provide this information to MOSAIC?: *: *

Yes

Applicant agreement

I agree that all information provided in this application is accurate and has been given voluntarily.

I understand that MOSAIC will keep my personal information private but may share part of it with the references I have provided, potential newcomers and government employees who evaluate the Culture Connections program.

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Workplace Connections Application Form

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Workplace Connections Application Form

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