New Mentor Online Sign-up Form

We would like to learn more about you to help us facilitate a great match!

Employer Information

Please indicate the name of the organization for whom you work:

Relevant Business Sector
---11_Agriculture & Animal Production21_Oil & Gas, Mining22_Utilities23_Construction & Engineering31_Manufacturing41_Wholesale Trade44_Retail Trade48_Transportation & Warehousing51_Cultural Industries52_Finance & Insurance53_Real Estate54_Professional and Scientific Services55_Waste Management61_Education Services62_Health Care and Social Assistance71_Arts & Entertainment72_Food & Accommodation Services81_Other Services91_Public Administration

City

Province or Territory
---AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

Postal Code

Are you or is your organization interested in offering mentoring opportunities to more than one protégé?
YesNoI do not know

If yes, how many?

Mentor information

First Name

Last Name

Job Title

Work Contact Information:

Email Address

Phone Number

How long have you worked for this business or organization?
Less than 5 years5 or more years

This is my first time participating as a mentor in the MentorAbility initiative.
YesNo

I am willing to offer the following type of mentoring experience(s) (click all that apply):
Online, virtual mentoring experienceIn-person, onsite mentoring experience

I am interested in mentoring to:
Build my leadership skillsLearn new perspectivesImprove my professional skillsGain personal satisfaction

Other:

My employer is supportive of my participation in this initiative.
YesNoUnknown

How did you learn about MentorAbility Canada?

Mentor’s Statement of Participation

What specific jobs or career mentoring can you offer?

As a mentor participating in the MentorAbility Canada project:
I agree to plan for a meaningful mentoring experience for the protégé,
I agree to provide the protégé with encouragement and advice to help them learn more about my place of work, sector, and or role, and
I agree to have online or in-person time with the protégé

This online or in-person mentoring experience may include:
Sharing personal insights about my career pathWork-site tour and meeting with employeesJob shadowing with an existing employeeHands-on experience supervised by an existing employeeMeeting with an HR Professional

I anticipate that the MentorAbility Experience will last for:
Under 3 hoursHalf working dayOne working day

Mentor’s Authorization:

I give consent to the MentorAbility Canada Project to use photographs or videos of myself for promotional or documentation use.

I give consent to the MentorAbility Canada Project to use my name when documenting the mentoring experience for promotional use.

After the mentoring experience, I agree to give feedback on my MentorAbility Experience to help evaluate and improve this initiative.

I prefer to provide my feedback: (click all that apply)
by telephone interviewby confidential survey

Receiving Information

I would like to receive information from the Canadian Association for Supported Employment.
Information includes emails, event invitations, newsletters, and announcements. I understand that I
can unsubscribe at any time.
YesNo

Additional Information:

How did you learn about MentorAbility Canada?
---Supported employment service providerWebsiteSocial Media (LinkedIn, Facebook, Instagram, Twitter)Friend/colleague

Other:

MentorAbility Canada follows good safety and security standards. In addition, general liability coverage is provided for all MentorAbility Canada Project protégés during their mentoring experiences.