MENTOR APPLICATION

Thank you for your interest in joining our family of Second Chance Mentors.
Please fill out the application below and someone from Second Chance Support Network will get in contact with you.

First Name

Last Name

Home Street Address

City

State

Zip Code

Date of Birth (MM/DD/YYYY)

Phone Number

Employer

Occupation

Do you have a valid drivers license?

Yes

Do you have transportation?

Yes

What Church do you attend?

References

Pastor's First Name

Pastor's Last Name

Pastor's Address

Pastor's Phone Number

First Name

Last Name

Address

Phone Number

Relationship

Please describe why you want to mentor:

How did you hear about Second Chance Support Network?

I understand the need to secure a background check into my personal references and my person and criminal history to determine my fitness to serve as a Mentor associated with local or state law enforcement agencies and their subsidiaries. I waive my right to confidentiality and authorize the release to Second Chance Support Network (SCSN) Ministries any personal background information from any source, in its investigation of my criminal history (Drivers License # and SSN will be obtained by a SCSN Ministries representative in order to perform a background check). I fully understand and agree to assume all risks involved in any and all duties that I perform in a volunteer capacity on behalf of or in connection with SCSN Ministries. I agree to hold SCSN Ministries and its representatives harmless for any injury(s), loss or damages which I might sustain during the course of my volunteer duties. This waiver does include myself, all of my family members and descendants from seeking any legal action whatsoever against SCSN Ministries or any representatives thereof.

Thank you for volunteering to become a mentor! Someone from the Second Chance Support Network will be in touch with you shortly.

Please provide Second Chance Support Network with one pastoral and one personal reference:

Pastoral Reference

Personal Reference

The feeling of helping others and making a difference in our community is priceless.

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