Best Kids (DEV)

 

This Application must be completed in one sitting. Although it may not timeout clicking, back on your browser will result in a loss of data. Please have your license, reference information and 18 years of residency history prepared before starting. If you have any questions, comments, and/or concerns regarding the online application please call the Enrollment and Training Coordinator, Jennifer Dysart, at 202-397-3272 ex 103. Thank you and we look forward to reviewing your application!

* - Required field

Basic
* First Name
* Last Name
* Date of Birth
* Gender
* Primary Phone
* Secondary Phone
Current Address
* Home Address 1
* Home Address 2
* Home City
* Home State
* Home Zip code
Social Security Number
* Date of Initial Application
* E-mail address
* Confirm Email Address
* Have you ever been known by a different name?
YesNo
Other names known by
Please list all members of your household (including gender)
Eligibility Information
* Can you commit to participate in the BEST Kids Mentoring Program for a minimum of one year from the time you are matched with a youth?
YesNo
* Are you available to meet with a child an average of ten hours per month and have contact at least once per week?
YesNo
Please explain any particular scheduling issues
* Are you willing to submit monthly reports regarding your mentoring activities at least once a month?
YesNo
* Are you willing to communicate openly with program staff and receive feedback regarding any difficulties during your participation in the mentoring program?
YesNo
* Are you willing to attend a 2 hour orientation and complete 4-5 hours of online training to become a mentor?
YesNo
Educational Background
High School
High School
City, State
Year graduated
College (if applicable)
College
City, State
Year graduated
Graduate School (if applicable)
Post Graduate School
City, State
Year graduated

Please list your last 3 employers.
Employment History
This entry will be deleted on submit!
 
* Employer Name
Employer Address
Employer Zip Code
Position Held
Start Date
End Date
This entry will be deleted on submit!
 
* Employer Name
Employer Address
Employer Zip Code
Position Held
Start Date
End Date
This entry will be deleted on submit!
 
* Employer Name
Employer Address
Employer Zip Code
Position Held
Start Date
End Date


Please list all current and previous experience working with children, whether in a volunteer or compensated capacity.
Experience with Children
This entry will be deleted on submit!
 
Name of Organization
Supervisor Contact Information (phone and/or email)
Your Responsibilities
Age Range of Children
Reason for Leaving

Application Questions
* How did you hear about BEST Kids?
* Why do you want to become a mentor?
* What qualities, skills, or other attributes do you feel you have that would benefit a youth?
* How would you describe yourself?
* Have you ever been convicted of drinking and driving?
YesNo
* If yes, when?
* Have you ever received treatment for alcohol or substance abuse?
YesNo
* If yes, please explain.
* Have you at any time during the past five years used illegal drugs or other illegal controlled substances?
YesNo
* If yes, what substances were used and how often?
* Have you ever been treated or hospitalized for a mental disorder?
YesNo
* If yes, please explain
* Have you ever abused a minor or engaged in any conduct that could be regarded as child abuse or neglect, including but not limited to murder, abduction for immoral purposes, sexual assault, failing to secure medical attention for an injured child, pander, crimes against nature involving children taking indecent liberties with children, neglect of children,obscenity offenses, or similar moral impropriety involving children?
YesNo
* If yes, please explain
* Have you ever been convicted of or pleaded guilty to, or are charges pending against you concerning any other crime?
YesNo
* If yes, please explain
* Do you have any reason to believe that a check on you with the National Crime Index Service, Central Criminal Records Index, and national child abuse databases, as well as local law enforcement officials and child protective services would disclose any negative information?
YesNo
* If yes, please explain
* Do you agree to submit your electronic finger print cards to allow your criminal history background check to be released to BEST Kids and CFSA ?
YesNo
Driving Record
In what state are you currently licensed to operate a motor vehicle? Please list your license number and type of license.
State
License Number
License Type
Please list all states where you have previously held a license to operate a motor vehicle and the years held during the past ten years.
Please list any motor vehicle violations (excluding non-moving violations) filed against you during the past ten years.
References
Please list the names, addresses, and phone numbers of three people you would like to use as character and professional references. Provide one professional reference, and one reference who can speak to your suitability to work with youth. Please list only people you have known for at least a year. Any information BEST Kids Mentoring Program gathers from these references will be held as confidential and not released to you. Three references are required
Reference 1
First Name
Last Name
Relationship
Length of Relationship
Phone
Secondary Phone
Reference 2
First Name
Last Name
Relationship
Length of Relationship
Phone
Secondary Phone
Reference 3
First Name
Last Name
Relationship
Length of Relationship
Phone
Secondary Phone
Reference 4
First Name
Last Name
Relationship
Length of Relationship
Phone
Secondary Phone
Agreements
Please read this carefully before signing. Please check each of the following:
I understand that BEST Kids Mentoring Program is not obligated to provide a reason for their decision in accepting or rejecting me as a mentor.
I agree to allow BEST Kids to use any photographic image of me taken while participating in the mentoring program. These images may be used in promotions or other related marketing materials.
I agree to allow BEST Kids to perform a criminal background check on me at least once every two (2) years.
Statement and Release

 

I understand I must return all of the following completed items before approval to be a mentor
(BEST Kids staff will assist in this once the completed application is turned in):
 
 * Signed Requirements and Responsibilities of a BEST Kids' Mentor
 * A copy of your valid driver's license and proof of auto insurance (if applicable)
 * Certified Record of Driving History
 * A notarized Child Protective Registry Form (performed every year) for DC and any locations applicant has lived in past 5 years
 * DC Police Clearance
 * Police Clearance from other jurisdictions where applicant has lived in the past 5 years
 * FBI Crimal History Clearance
 * CFSA/BEST Kids Confidentiality form
 * Medical Clearance
 * TB Clearance
 
By signing below, I attest to the truthfulness of all information listed on this application and agree to all the above terms and conditions.
 
Applicant's Statement and Verification
 
The information contained in this application is true and correct to the best of my knowledge. I authorize you to contact any references or organizations listed in this application and accompanying forms and authorize such references or organizations to give you any information they may have regarding my character and fitness for working with children and/or youth. I release BEST Kids, Inc., all of its agents, and all such references and organizations from any and all liability for any damage that may result from furnishing such evaluations to you, and I waive any right that I may have to inspect references provided on my behalf.
 
I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW AND UNDERSTAND THE CONTENTS THEREOF. I SIGN THIS RELEASE AS MY OWN FREE ACT. THIS IS A LEGALLY BINDING AGREEMENT THAT I HAVE READ AND UNDERSTAND.
 
Further, I affirm that I have neither been convicted of nor pleaded guilty to, nor am I the subject of pending charges for any crime or misdemeanor involving actual or attempted child abuse or neglect or sexual molestation, including but not limited to murder, abduct for immoral purposes, sexual assault, failing to secure medical attention for an injured child, pandering, crimes against nature involving children, taking indecent liberties with children, neglect of children, obscenity offenses, or similar moral impropriety involving children, in the District of Columbia, or in any other jurisdiction. I recognize and agree that, as a condition of my volunteer work and/or employment, I will be required to consent to and/or furnish to BEST Kids, Inc., a criminal conviction records check from the Central Criminal Records Exchange or comparable criminal records and/or background check and consent to do so realizing the importance of promoting BEST Kids, Inc., ability to protect those under its care. 
I understand that all employees and volunteers who work directly with children must submit to a fingerprint check by the Federal Bureau of Investigation and/or possibly other federal and state authorities. I agree to fully cooperate in providing and recording as many sets of my fingerprints as are necessary for investigation by federal and/or state authorities as appropriate.
 
Should my application be accepted, I agree to be bound by all policies, standards, training, and regulations of BEST Kids, Inc., including but not limited to Requirements and Responsibilities for Mentors, the volunteer and/or employee manual and policy and procedures manual, and to refrain from all illegal and/or improper conduct in the performance of my services on behalf of BEST Kids, Inc. Refer to BEST Kids, Inc. website at www.bestkids.org and the mentor log-in for updated policies and procedures.
I hereby affirm and acknowledge by signing immediately below, that all of the information provided and all of my answers to the foregoing questions are true and complete, and that any misrepresentation or mission may be grounds for rejection or, if later engaged as a volunteer or employee, dismissal. I declare that the foregoing is true and correct. 
 
Information Release
 
I understand it will be necessary for BEST Kids Mentoring Program to conduct a background check regarding my driving record, criminal history, personal and professional references, child protective registries, child abuse and neglect registries and employment. I also understand it is necessary for me to release Health Certification and Drug Screening information to BEST Kids and the District of Columbia’s Child & Family Services Agency. 
 
I authorize BEST Kids Mentoring Program to obtain any needed information regarding my driving record, legal/criminal history, child protective registries, sexual offender registries, child abuse and neglect registries, character references, from any state or federal agency, my employer, and personal and professional references for the purposes of participating in a mentoring program. Further, I provide permission for BEST Kids Mentoring Program to conduct the same investigation of my background in previous states in which I have resided. I also provide permission for BEST Kids™ Mentoring Program to conduct the same investigation on an annual basis as long as I remain a mentor with the BEST Kids Mentoring Program.
 
Further, I understand that information about myself will be anonymously (without my name) shared with a prospective mentee(s) and his/her parent(s)/guardian(s) to aid in determining a suitable match. Once a mentor/mentee match is determined, my identity and any other information known about me may be shared with the mentee and parent/guardian to ensure and aid in facilitating a safe and successful match relationship. 
Electronic Signature Agreement
 
By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide BEST Kids, Inc. instructions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and BEST Kids, Inc. You further agree that each use of your E-Signature in the BEST Kids' Mentor Application constitutes your agreement to be bound by the terms and conditions of BEST Kids' Mentoring Program as they exist on the date of your E-Signature. 
 
To obtain electronic services and communications, indicate your consent to the terms and conditions of this Agreement by clicking on the "I Accept" checkbox.
 
* I Accept
* Signed Date