Derbyshire and Nottinghamshire Branch

Mentee/Coacheeapplication form

- Part II-

Personal Profile

Please note that information provided on this form will be shared with Mentors as part of the matching process. You are required to complete all sections and provide us with as much information as you feel necessary to enable us to find you a suitable partner.

Thank You

Name:
A)Support for Upgrading or Experience Assessment: / * Delete as appropriate
i)Are you seeking support to Upgrade your professional level of membership? / Yes / No / N/A *
ii)Are you seeking support relating to the Experience Assessment route to membership? / Yes / No / N/A *
If YES to either of the above - which level of professional membership are you seeking to achieve? / Assoc CIPD (EA only) *
Chartered MCIPD *
Chartered FCIPD *
B)Current (or most recent) work experience **
Current Employer:
Sector / Industry:
Work Base / Location (town):
Job Title:

Are you a student please? No *Yes - Part-time* Yes - Full time* (*Delete as appropriate)

Name of your college / university:
What are you studying?
C) Logistics **
Where are you prepared to travel to meet your Mentor/Coachee for meetings? (Please be as specific as possible indicating any towns/cities and/or areas and also tell us if you are reliant on public transport).
What time of day will you be available for mentoring meetings?
How frequently would you like to meet?
(Please be realistic in terms of what fits with your work load/schedule? The Branch scheme entitles you to approximately 6 months support / 4 to 6 meetings).
D)Background information to assist with pairing you with a suitable Mentor/Coach

i)What are your main areas of HRM / HRD knowledge, skills and experience?

ii)Please indicate in the box below what the main reasons are for wanting a Mentor/ Coach, and the key areas you need help with at the moment. For example:

  • What are you struggling with at the moment?
  • What issues you feel you need to resolve?
  • What aspects do you feel you need to develop further?

(Please give as much information as possible - the detail you provide here will help form your mentoring objectives and goals)

iii)What do you hope to gain from a Mentoring/Coaching partnership?

E)Describe the type of individual you believe would be best suited to you within the mentoring relationship. Please use indicators such as sector / industry; experience / education; CIPD Professional Map / Membership level etc. as you feel appropriate.

Have you had a Coach or Mentor before? Yes / No *

(If yes, please provide brief details)

I declare that the information given on this form is correct at the time of completion, and that I understand this will be shared with Mentors/Coaches on the Branch Register to assist with the matching process.

Signed: / Date:
Please print name:

Please complete and return both Part I & II of your Application Form in WORD format to our

Mentoring Coordinator

Information supplied on this form will only be used for the purposes of administering the Mentoring & Coaching Programme.

For your security and peace of mind, CIPD and its subsidiaries will not supply your details to any organisation for marketing purposes. By submitting this order you confirm that you agree to the use of your information as set out in ourPrivacy Policyand agree to our websiteTerms and Conditionsof use.

Mentoring Programme Mentee Application form Part II – Revised Mar 2017