Mentor Application

Please fill in the details as completely as possible:

Date
Name
Address
City
State
Postal Code
Home Phone
Work Phone
Mobile Phone
Email
Date of Birth
Employer
Position
Education
Special Training
Church Membership
Pastor's Name
Emergency Contact
E Contact Home Phone
E Contact Work Phone
E Contact Mobile Phone
Relationship
How did you hear about Christian Women's Job Corps?
Why do you want to server as a mentor?
Tell us about yourself
What spiritual gifts, skills, abilites, talents, traits, experiences, etc., do you bring to the mentoring relationship?
Have you accepted Jesus Christ as your personal Lord and Savior? YesNo
Will you commit to attend any scheduled mentor meetings? YesNo
Do you give permission for a background check to run on you? YesNo
Please provide us with three personal references (Include: Name, Relationship, Preferred Phone, and Email)