Mentor Application

 

Thank you for your interest in becoming a mentor with Community for Youth (CfY). Before you start the application, please note that the application cannot be saved. The application process will not take more than 20-25 minutes of your time. And if you have a car, please have your auto insurance information and driver's license ready. 

It is the policy of Community for Youth that no one shall be discriminated against or suffer harassment on the basis of race, color, sex, religion, sexual orientation, age, disability, national origin, citizenship, veteran status, or any other reaons prohibited by law. Everyone is welcome to apply and will be considered without regard to the above mentioned discrimnation.

* Required Fields
Personal Information
Emergency Contact
Employer Information
Personal References
Driving Information
Special Certificates
Criminal History
Applicant/Volunteer Disclosure Form
  1. Have you ever been convicted of any crimes against persons as defined in Section 1 of Chapter 486, Laws of 1987, and listed as follow: Aggravated murder; first or second degree murder; first or second degree kidnapping; first, second or third degree assault; first, second or third degree rape; first, second or third degree statutory rape; first or second degree robbery; first degree arson; first degree burglary; first or second degree manslaughter; first or second degree extortion; indecent liberties; incest; vehicular homicide; first degree promoting prostitution; communication with a minor; unlawful imprisonment; simple assault; sexual exploitation of minors; first or second degree criminal mistreatment; child abuse or neglect as defined in RCW 26.44.020; first or second degree custodial interference; malicious harassment; first, second, or third degree child molestation; first or second degree sexual misconduct with a minor; patronizing a juvenile prostitute; child abandonment; promoting pornography; selling or distribution erotic material to a minor; custodial assault; violation of child abuse restraining order; child buying or selling; prostitution; felony indecent exposure; or any of these crimes as they may be renamed in the future.  
  If yes to question 1, please explain below. If No, please enter N/A.  
  2. Have you ever been found in any dependency action under RCW 13.34.030 (2) (b) to have sexually assaulted or exploited any minor or to have physically abused any minor?  
  If yes to question 2, please explain below. If No, please enter N/A.  
  3. Have you ever been found by a court in a domestic relations proceeding under Title 26 RCW to have sexually abused or exploited any minor or to have physically abused any minor?  
  If yes to question 3, please explain below. If No, please enter N/A.  
  4. Have you ever been found by the final decision of any disciplinary board or of the Department of Licensing to have sexually abused or exploited any minor or to have physically abused any minor?  
  If yes to question 4, please explain below. If No, please enter N/A.  
  By entering my name here, I certify under penalty of perjury under the laws of the States of Washington that the information I provided above is accurate and true.  
Mentor Contract

Privacy Policy
We keep your personal information private and secure. When you submit this form, your name, contact information, and any additional information will be available only to our organization.



 

Community for Youth 

999 Third Avenue, Suite 1080
Seattle, WA 98104-4015
t: 206.325.8480

©2018 SofterWare, Inc. v.2018.02.01-A