Volunteer Mentor Application Form June 19, 2015 by wjn in EXPRESSION OF INTEREST PLEASE FILL IN ALL FIELDS First Name Last Name Address Postcode Suburb State — None —Australian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Occupation: Phone: Email: Date of Birth: Cultural Background: — None —AustralianAboriginal and Torres Strait IslanderPacific IslanderVietnameseOther Do you fluently speak any languages other than English? — None —YesNo If yes, what language/s? Do you hold a current drivers licence? — None —YesNo Do you have access to a vehicle? — None —YesNo Current employment status: — None —F/TP/TStudentHome DutiesRetiredUnemployed Do you have any circumstances that may impact your ability to act as a mentor? — None —YesNo If yes, please specify: I am a Australian citizen or permanent resident: — None —YesNo Please list any previous volunteering you have done: How did you hear about WJN’s Mentoring Program? — None —Word-of-mouthOnlineSocial MediaRecruitment AdOther Other, please state: Why are you interested in becoming a mentor with WJN?: What personal qualities or life experience can you bring to WJN’s Mentoring Project?: Do you have any connections, either personal or professional, with the criminal justice system?: — None —YesNo If yes, please provide details. Please note, answering yes to will not affect your eligibility to become a WJN mentor: Are you willing to enter into and sign a Mentoring Agreement? — None —YesNo Are you willing to abide by a Mentoring Code of Conduct? — None —YesNo Can you commit to 12-month participation in WJN’s Mentoring Program? — None —YesNo Do you agree to participate in 2-day training? — None —YesNo Do you agree to attend on-going training and supervision every 6-weeks? — None —YesNo Please supply email contacts for two character references: Your mentee, Kate, is an Aboriginal woman in her 40s. She has recently been released from custody for alcohol related theft and assault. Kate wants to get her life back on track but is feeling overwhelmed and doesn’t think anyone understands her. She is unable to see any of her four children and reports feeling depressed. Kate admits she has started drinking again and is scared she will end up back in custody. As Kate’s mentor how do you think you could best support her? Please note a confirmation email will be sent to the listed email address. back to top ↑
