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Mentor Connect | Mentor

Mentor EOI Application

Mentor Expression of Interest

Applicant Details:

First Name

Last Name

Email*

Phone

Current/most recent role and title?

Current Employer (if applicable):

How many years have you been in current role to date?

Application Information

Business Industry:

Please nominate the industry segment and role that best matches your business and current position.

Industry Segment

Industry Other...

Role

Role other...

Business Owners

If you own a business, please nominate your business structure

Is your business home based?

Describe your business or employment

What other professional disciplines/functions do you have experience in, either here or with other employers?

_________________________________

Other mentoring fields...

Why be a mentor?

Everyone chooses to mentor for a variety of reasons. Please give us an insight into why you would like to be considered a mentor in this program.

Do you have any previous mentoring experience? Please detail...

What skills do you possess that you believe will add value to a mentee?

Would you be interested in taking on more than one mentee? (Each mentee relationship would be one-on-one for two/one-hour sessions). If yes, what is the maximum number of mentees you would be willing to commit to in the first instance?

Are there any other key business strengths you feel you can bring to your mentee?

Do you have a current National Police Clearance?

Do you have a current Working With Children check?

If not, are you prepared to apply for these documents?

I can provide a photograph of myself for the Mentor Connect program...

Mentor Declaration | By submitting an expression of interest to be a mentor, I acknowledge and accept the following:

1. I have read and understood the mentoring program guidelines*

2. I understand WiBRD can take no responsibility for any advice or information exchanged between myself and a mentee or a mentor*

3. My name, preferred contact details, professional photograph and employment details will be made available on the Mentoring portal as a part of this program*

4. I will discuss and complete a mentoring agreement with my mentee to help ensure clarity and shared expectations.*

5. I will treat in the strictest confidence all information and matters discussed in a mentoring relationship with a mentee.*

6. I will provide feedback as requested to enable effective evaluation of the WiBRD Mentor Connect program*

Please verify your request*

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Executive Officer
Jacinta Jones
[email protected]
0408 138 127

PO BOX 9432 | Mount Gambier West | SA | 5291