Mentor Qualification - Phase 1* =============================== [*There are two phases in this process; the 2nd phase information is at the bottom of this page.] Please provide the following information. All of the information, except for your resume, can be filled in below. Please send this completed form and your resume to register@getmagic.org. Basic Information ------------------ Name: Previous names used: Year of Birth: Place of Birth: Name of spouse: Residential address: Work Phone: Residential Phone: Addresses for the past five years: Employer's name and address: Resume - Please attach. Can we contact your employer for a reference? Previous mentoring experience: 2 references- preferably from the previous mentoring experience, if any: Other - Please respond in yes or no ----------------------------------- Will you be able to devote 2-3 hours per week to mentoring? Do you have email access? Will you be able to bear the cost of 2-3 hours per week of phone calls as required? Will you be available for a phone interview with MAGIC? Are you willing to be finger-printed and screened? Will you be able to pay up to $50 for the finger-print screening? Have you ever been arrested, cited or detained by a law enforcement officer? Have you ever been charged with committing a legal offense? Have you ever been placed in alternative sentencing? Have you ever been to jail? Have you ever received a suspended sentence? Have you ever committed a crime for which you were not arrested? Have you ever taken drugs? Do you have any reason to believe that you are any more than a social drinker? Is there any additional information that you would like us to know? Other Details ------------- Are there any specific days/times that you would like to mentor? Do you have a specialty area you would like to focus on? Note about background check (Phase 2): -------------------------------------- We are going to use the following agency (it does an FBI based fingerprint check) http://apps.mentoring.org/safetynet