E34 Mentoring

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E34 Mentoring Application 

2020-2021
E34 is our mentoring program here at Urban Youth Impact. Our mission is to empower students with the love of Christ by doing life together as we build into them spiritually, physically, and socially. 

E34 is short for Ezekiel chapter 34. In this passage, God is calling His people to action and challenging us to go out and care for His sheep. It is our responsibility as believers to take care of those around us, especially the little ones. Children hold a special place in God's heart and therefore should hold a special place in our heart, as well. 

Contact Information











Education 







Current Employer







References 

Please include a reference from a church leadeand a reference from a friend, preferably a Christian, who has known you for more than one year.

Church Leader






Personal Reference (non-family member, spouse, or significant other) 





Please Answer the Following Questions

We would like to learn about your interest in serving in this ministry, your understanding of the Bible, and your walk with God.






















CONFIDENTIAL INFORMATION

Please answer the following questions honestly. Your answers will not automatically disqualify you from being a volunteer at Urban Youth Impact. 










BACKGROUND CHECKS

Please be advised that Urban Youth Impact reserves the right to perform county, state, and federal background checks on every Volunteer MentorWe take the protection of our children very seriously.

I hereby authorize, without reservation, the obtaining of “consumer reports” or “investigative consumer” reports by Urban Youth Impact at any time after receipt of this authorization and throughout my employment or volunteer service, if applicable. I further authorize and request, without reservation, any present or former employer, school, police department, state or federal agency, financial institution, division of motor vehicles, consumer reporting agencies, or other persons or agencies having knowledge about me to furnish LexisNexis or Urban Youth Impact with any and all background information in their possession regarding me, so that my employment qualifications may be evaluated and/or reassessed. I also agree that a fax or photocopy of this authorization with my signature should have the same authority as the original. 

By signing below, I certify that: (1) I have read and fully understand this disclosure and authorization; (2) all of the information I am providing is true, complete, correct, and accurate; and (3) I have received the attached Summary of Your Rights under the Fair Credit Reporting Act (15 U.S.C. §1681 et seq.). 














***The following is information required in order for Urban Youth Impact to obtain a complete consumer report. This information will be used for background screening purposes only. 

DISCLOSURE

In connection with your application for employment or volunteer service with Urban Youth Impact (including any independent contract for services) or when deciding whether to modify or continue your ongoing employment (if hired) or service, Urban Youth Impact, may obtain a “consumer report” and/or an “investigative consumer report” on you from LexisNexis, a consumer reporting agency, or from any third party, in strict compliance with both state and federal law. 

A consumer report is a communication of information by a consumer reporting agency bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used for purposes of serving as a factor in establishing your current and/or continuing eligibility for employment purposes. 

An investigative consumer report is a report obtained through personal interviews with individuals who may have knowledge of your character, general reputation, personal characteristics, or mode of living. The consumer reports or investigative consumer reports may contain information regarding your credit history (if applicable to position), criminal records, driving history records, education records, previous employment history, social security traces, military records, professional licensure records, drug testing, government records, and other types of background information.

You further understand that these reports may contain information concerning the reasons for termination of past employment. You are hereby notified that you have the right to make a timely request for the nature and scope of any investigative consumer report. You are further notified that, prior to being denied employment based in the whole or in part on information obtained in the consumer report, you will be provided a copy of the report, the name, address, and telephone number of the consumer reporting agency and a description in writing of your right under the Fair Credit Reporting Act. Inquires to LexisNexis should be directed to LexisNexis.

CRIMINAL RECORD HISTORY

Please answer the following questions truthfully. If you answer "Yes" to any of the questions, please include an explanation. 















VOLUNTEER WAIVER

I understand and affirm under oath to the truthfulness of the claims made herein and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Under penalties of perjury, I declare that I have read the foregoing and the facts alleged are true to the best of my knowledge and belief. 



RELEASE OF CONTACT INFORMATION

I understand that my phone number and email may be shared with other volunteers serving in the same ministry for replacement purposes if they need to find someone to switch weeks with them.