Volunteer Mentor Application ← BackThank you for your response. ✨ Full Name(required) Address(required) Email(required) Phone(required) Date of Birth (YYYY-MM-DD)(required) Marital Status(required) Select one option Married Single Occupation(required) Are you a citizen of Kenya?(required) Select one option Yes No Have you ever been convicted of a crime?(required) Select one option Yes No If you answered ‘yes’ to the question above, please provide further information: Name of High School Attended(required) Which year did you complete High School?(required) Please provide three references. These references should all be individuals who have known you for at least one year. You may list former teachers, employers, community friends, co-workers, a close family member (only one), or your pastor. Reference #1 Name(required) Reference #1 Phone Number(required) Reference #1 Email Address(required) What is your relationship with this person?(required) Select one option Family Member Pastor Employer Co-Worker Friend Other Reference #2 Name(required) Reference #2 Phone Number (required) Reference #2 Email Address(required) What is your relationship with this person?(required) Select one option Family Member Pastor Employer Co-Worker Friend Other Reference #3 Name(required) Reference #3 Phone Number (required) Reference #3 Email Address(required) What is your relationship with this person?(required) Select one option Family Member Pastor Employer Co-Worker Friend Other Current Eployment Information Company Phone Number Name of Supervisor Job Title May we contact your supervisor as a reference? Select one option Yes No Kindly explain why you want to volunteer with Daraja la Amani: DISCLAIMER I understand that: The references listed may be contacted by phone or email The information I provided may be used to conduct a background check and criminal background check Daraja la Amani is not obligated to match you with a young adult or enlist you as a volunteer Daraja la Amani can discontinue your volunteer services at any time based solely on their professional decision to do so This is a volunteer position, meaning you will not be paid for your services If this application leads to a position as a volunteer, I understand that false or misleading information in my application or interview may result in a discontinuation of my volunteer services. By submitting this form, you’re agreeing to the disclaimer statements listed above. SendSubmitting form Δ
Daraja la Amani