TRAIL-BLAZERS - Mentor Application Form

Please complete using black ink.

Post completed form to Trail-Blazers, HMYOI Aylesbury, Bierton Road, Aylesbury, BUCKS, HP20 1EH

Surname: ……………………………….. First names: ………………………………………………… ……..
Which prison do you wish to apply for? Where did you see the position advertised?

Contact details

Home address:…………………………………...……………………………………………………………………...
……………………………………………………..……………………………………………………………………...
……………………………………………………..……………………. Postcode………………………………...
Daytime Tel. No. ………………………….……… Mobile No………...…………………………………
Evening Tel. No. …………………………….…… Email: ……………………………………………….

Education

Please, list qualifications with dates and include any courses/training you currently attend (continue on separate page if required)

Current Employment

Name and address of current employer:
……………………………………………………………………………………………………………………………..
……………………………………………………….………………. Postcode…………………………..………...
Tel. No. …………………………………… Position held: ………………………………………….…………….
Start date: ………………………………… Full/Part-time ……………………………….……………………….
Main duties:

Previous employment - Please list details of last 10 years, most recent first

Employer's name and nature of business / Position held and duties / Dates

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Do you have any voluntary work experience?

Please give details including dates

Do you have any experience in the areas of: offending, youth, drugs, alcohol, homelessness, counselling, advice/guidance?

Please give details including dates

Interests/hobbies/sports

Why do you want to be a volunteer Mentor and what do you think you will gain from it?

Commitment

The commitment would be one visit per week in prison for up to 6 month and once fortnightly in the community for up to 9 months. Please state if you are able to meet this commitment.
YES / NO
Mentees are released to areas that could be a considerable way away from the prison and Mentors are required to travel to meet their Mentees. Please confirm you will be able to do this.
YES / NO

Travel

Do you have a driving licence? YES / NO
Do you have access to a car? YES / NO

Residency

I have the right to remain in the U.K. for an unlimited period and have the appropriate documentation available to be viewed.
YES / NO

Health

How many days have you been off sick in the past two years?
Have you suffered from any serious illness within the last two years?
Do you consider yourself to have a disability? YES / NO
If YES, please give details and explain any particular requirements you may have

References

Please give the names and addresses of 3 referees who can comment on your skills and abilities for this position. One of these referees must be your current or a recent employer. Family members will not be accepted as referees. Telephone numbers MUST be supplied.

Current (last) Employer
Name ……………………………………………………………………………………..………………………………
Address …………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………..
……………………………………………………………………… Postcode………………………………...…
Tel. No:………………………………………………. Email:………………………………………..………………
Please state your relationship: ………………………………………………………………………...………………
May we take up the reference now? YES/NO
Referee Two
Name ……………………………………………………………………………………..………………………………
Address …………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………..
……………………………………………………………………… Postcode………………………………...…
Tel. No:………………………………………………. Email:………………………………………..………………
Please state your relationship: ………………………………………………………………………...………………
May we take up the reference now? YES/NO
Referee Three
Name ……………………………………………………………………………………..………………………………
Address …………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………..
……………………………………………………………………… Postcode………………………………...…
Tel. No:………………………………………………. Email:………………………………………..………………
Please state your relationship: ………………………………………………………………………...………………
May we take up the reference now? YES/NO

Rehabilitation of Offenders Act

The post for which you are applying is exempt from the provision of the Rehabilitation of Offenders Act 1994. It is a condition of volunteering that all convictions (served, pending, spent and unspent) and cautions are disclosed. Applicants with any convictions, cautions or pending court cases must provide details on a separate sheet. If this is not applicable to you, please write the declaration: 'I have no convictions, cautions or pending court cases' in the space below *. Any information given will be considered only in relation to the application for position to which the order applies. Failure to disclose such information could result in subsequent dismissal from Trail-Blazers Mentoring Programme. A criminal record will not necessarily prevent entry onto the programme.

*Declaration: …………………………………………………………………………………………………………...

I declare that, to the best of my knowledge, the information contained in this form is true and accurate. I understand that if it is subsequently discovered that any statement is false or misleading, any offer of training may be rescinded and/or the mentoring position may be immediately terminated.

Signed …………………………………………………..………… Date ….…………………………….………

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