Career Mentor Application Your Name(Required)(first/middle/last) Other names you have used(maiden, nicknames) Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long have you lived at this address?(Required) How long have you lived in the state of Washington?(Required) Phone(Required)This will not be publicly shared.Email(Required)This will not be publicly shared. Preferred Method of Communication(Required) Phone Call Text Email Date of Birth(Required) MM slash DD slash YYYY Gender(Required) Name as it appears on your Washington State Driver's License(Required) Washington State Driver's License Number(Required) Washington State Driver's License Expiration Date(Required) MM slash DD slash YYYY Primary Language(Required) Secondary Language Ethnicity(Required) Career Focused Interests(Required)Education Level(Required) Employer(Required) Current Occupation(Required) Professional Bio(Required)This information will be public on the website. (include industry(s) and occupation(s)/title(s), education/experience, skills)Headshot Image(Required)Please upload an image of yourself for the website.Accepted file types: jpg, jpeg, png, Max. file size: 150 MB.Why do you want to be a career mentor for youth?(Required)Previous volunteer experiencePrevious work with youthWhat are your interests and/or hobbies?To what service or social groups do you belong?Select IndustriesSelect the industry or industries that you are experienced in. These will show up on the mentor page as a search filter. If none of these industries are relevant please fill in the text box below.Industry Categories(Required)click all that apply Accounting Airlines Alternative Dispute Resolution Animation Apparel & Fashion Architecture & Planning Arts & Crafts Automotive Aviation & Aerospace Banking Biotechnology Broadcast Media Building Materials Business Supplies & Equipment Capital Markets Chemicals Civic & Social Organizations Computer Games Computer Hardware Computer Networking Computer Security Computer Software Construction Concrete Consumer Electronics Consumer Goods Consumer Services Cosmetics Dairy Defense & Space Design Education (Management) Education (Higher) Education (Primary/Secondary) E-Learning Electrical/Electronic Manufacturing Engineering (Civil) Engineering (Industrial) Engineering (Mechanical) Entertainment Environmental Services Events Services Executive Office Facilities Services Farming Financial Services Fine Art Fishery Fitness Food & Beverage Food Production Fund-Raising Furniture Gaming & Casinos Glass, Ceramics Government Administration Government Relations Graphic Design Health & Wellness Hospital & Health Care Hospitality Human Resources Import & Export Individual & Family Services Industrial Automation Information Services Information Technology Insurance International Affairs International Trade & Development Internet Investment Banking Investment Management Janitorial Services Jeweler Journalist Judiciary Law Enforcement Law Practice Legal Services Legislative Office Leisure, Travel & Tourism Libraries Luxury Goods & Jewelry Logistics & Supply Chain Machinery Management Consulting Maritime Marketing & Advertising Market Research Media Production Medical Devices Medical Practice Medicine (Alternative) Mental Health Care Military Mining & Metals Mobile Games Motion Pictures & Film Museums & Institutions Music Nanotechnology Newspapers Non-Profit Organizations & Management Oil & Energy Online Media Outsourcing/Offshoring Package/Freight Delivery Packaging & Containers Paper & Forest Products Performing Arts Pharmaceuticals Philanthropy Photography Plastics Political Organization Printing Professional Training & coaching Program Development Public Policy Public Relations & Communications Public Safety Publishing Quality Control Analyst Quality Control Manager Railroad Railroad Manufacture Ranching Real Estate Real Estate (Commercial) Recreational Facilities & Services Religious Institutions Renewables & Environment Research Restaurants Retail Security & Investigations Semiconductors Shipbuilding Sports Sporting Goods Staffing & Recruiting Supermarkets Telecommunications Textiles Think Tanks Tobacco Translation & Localization Transportation Trucking Umpire Utilities Venture Capital & Private Equity Veterinary Vocation Instructors Warehousing Water Treatment Welder Wholesale Wine & Spirits Wireless Writing & Editing Xray Tech Zoology Other Industries not mentioned that is more suitable ReferencesName of Personal Reference(Required) First Last Personal Reference Phone(Required)Personal Reference Email(Required) Name of Professional Reference 1(Required) First Last Professional Reference 1 Phone(Required)Professional Reference 1 Email(Required) Name of Professional Reference 2(Required) First Last Professional Reference 2 Phone(Required)Professional Reference 2 Email(Required) BackgroundHave you ever been convicted of a crime?(Required) Yes No Crime conviction: if yes, please explain(Required)Have you ever had findings made against you for domestic violence, abuse, sexual abuse, neglect, exploitation of a child in any legal proceeding?(Required)These proceedings include judicial or administrative proceedings as well as finding by Department of Social and Health Services (DSHS) or the Department of Health that you have not challenged or appealed. Yes No If yes, please explain(Required)Do you currently have any criminal charges pending against you? Are you presently under investigation for possible criminal charges?(Required) Yes No Criminal charges: if yes, please explain(Required)Other than any matter listed previously, are there any facts or circumstances involving you and your background that would call into question EYN entrusting you with the supervision, guidance and care of a minor?(Required) Yes No If yes, please explain(Required)Do you object to this program running a criminal background check on you?(Required) Yes No If you have additional comments regarding your application information, please include here:Consent(Required)The Path Finder is a self-directed, youth-led tool for teens to access employment related resources as needed, including access to the career mentor network. Initial communication between a youth and career mentor will be through the Path Finder to a connected email address provided by the mentor. All communication through the portal is monitored by EYN. I understand that EYN/PtES reserves the right to accept or decline a career mentor based on compatibility with the program. Communication within the Path Finder tool between youth and career mentor or potential exploration opportunity is monitored by EYN. I understand it is the responsibility of the youth and career mentor/organization to conduct any continued communication/interaction outside of the Path Finder tool in a professional manner at all times. I agree to respond to all youth Path Finder communication within 24 hours or less of receiving within normal circumstances. I will comply and follow all requirements and procedures agreed upon as a PtES career mentor. I will report or consult with EYN’s Pathways to Employment Success program coordinator regarding any concerns or problems in a timely manner. I agree to allow the Empower Youth Network to run a criminal background check on me. All information in the application is accurate to the best of my knowledge. I agree to the statements above. Δ