Occupational Hygiene Mentoring Program
Application to Participate: For the Mentor
Please complete the following application and attach a recent resume. Be sure to clearly state your goals for participating in the program and realistically assess your knowledge/skill set so you can be matched to the most appropriate learning partner. Thank you.
GENERAL
Name:
Current job position, if applicable:
Phone number:
Fax Number:
Email address:
Education: What degree(s) do you have in what field(s)? When was it obtained?
Additional training and education: List any (recent) short courses, certifications, or additional training you have received and when.
BASIC COMPETENCIES
This information is being gathered to help identify skills or competencies you currently have to help make the best match with a learning partner. Not all of these skills can be addressed in one mentoring partnership. Please indicate which skills you think you could help a learning partner improve upon. Please be honest about your skill or experience levels.
CompetencyCurrent skill/experience level
Knowledge in basic sciences (chemistry, math, etc)12345
Broad occupational hygiene field practice12345
Writing ability12345
Organizational skills12345
Project management skills12345
Supervisory experience12345
Leadership qualities 12345
Networking techniques12345
1= rudimentary skill level
5=nearly proficient or proficient
Do you have particular strengths in any of the following rubrics? (circle those that apply)
Air sampling
Analytical chemistry
Biohazards
Biostatistics and epidemiology
Community exposure (air pollution, emission source testing, etc.)
Engineering controls
Ergonomics
Risk analysis and hazard communication
Management and ethics
Noise
Radiation
Toxicology
What are your specific goals for participating in the mentoring project?
Do you as a potential mentor have any specific knowledge you want to gain or skills you want to build?
What do you consider your greatest personal strengths or abilities? What do you do best? (Don’t limit yourself to work strengths)
Do you anticipate any challenges or obstacles to meeting these goals? (Time limitations, insufficient background in area, lack of managerial support, limited ability or time to travel to meet with a learning partner, etc.)
What type of individual do you think you would be most effective mentoring?
How will you know if you have been successful in reaching your goals as a mentor?
Please attach a resume and add any additional information you feel may be useful.
Mail to:Registrar CRBOH,224 Parkside Court, Port Moody, BCV3H 4Z8 or email: .
Business Address/Adresse administrative: 224 Parkside Court, Port Moody, British ColumbiaV3H 4Z8
Fax: (604) 949-8601 /
Head Office/Siège social: 253 College Street, Unit 333, Toronto, Ontario M5T 1R5