Required for background check.
If yes, please provide the address below.
Mentors must provide documentation along with this application validating that you are 21 years of age or older, having a valid driver license, and have auto insurance. These credentials allow you to participate in the Girl Talk mentoring program and to transport youth in any vehicle you are operating.
Please list four references who have known you for over a year and observed you with children. Do not include more than one family member.
Please provide us with at least three people you think would also make great mentors.
Statement of Agreement
I understand that: 1) The references I listed may be contacted by mail, e-mail or telephone; 2) I am in no way obligated to perform any mentor services; 3) The information I provided may be used to conduct a background check, to include driving records check, criminal background and sexual offender register registry checks and other records where required by local, state, or federal law for mentors working with youth; 4) I will provide documentation to transport youth in the vehicle I operate, which includes a valid driver’s license and current automobile insurance; 5) Girl Talk is not obligated to match me with a youth; 6) Other youth organizations where I have worked or volunteered may be contacted as references; and, 7) As part of the enrollment process, I will be asked to provide additional personal information prior to any recommendations for assignment.
Consent for Background Check
1. In connection with my application for volunteer work, I understand that an investigative criminal, sex-offender and motor vehicle report may be requested that will include information as to my character, work habits, performance, and experience, along with reasons for termination for past employment. I understand that as directed by company policy and consistent with the position described, you may be requesting information from public and private sources about my: driving record, credentials, criminal history records and references. 2. I acknowledge that a telephonic facsimile (FAX) or photographic copy shall be as valid as the original. This release is valid for most federal, state and county agencies. 3. By my signature below, I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, reference, or insurance company contacted by Girl Talk, Inc. to furnish the information described in Section 1. The following information is required by law enforcement agencies and other entities for positive identification purposes when checking public records. It is confidential and will not be used for any other purposes.
Girl Talk Inc. respects the confidentiality of “Little sister” mentee and “Big Sister” Mentor records and, with the exception of situations listed below, shares information about mentees and mentors only among the agency professional staff.
All records are considered the property of the agency and not the agency workers or mentees or mentors themselves. Records are not available for review by the mentees or mentors.
1. Information will be released to other individuals or non-Girl Talk Inc. organizations only with the “Little sister” mentee or “Big Sister” Mentor’s written consent…
2. Identifying information regarding “Little sister” mentees and “Big Sister” Mentors may be used in agency publications or promotional materials unless the clients or volunteer request otherwise.
3. Members of the Board of Directors or evaluators appointed by the Board have access to client files upon authorization of the Board of Directors.
4. Information shall only be provided to law enforcement officials or the courts pursuant to a valid and enforceable subpoena.
5. Information shall be provided to an agency’s legal counsel in the event litigation or potential litigation involving the agency.
6. State law mandates that suspected child abuse be reported to the Tennessee Department of Children’s Services.
7. If an agency worker receives information indicating that a “Little sister” mentee or “Big Sister” Mentor may be dangerous to himself or herself or to others, necessary steps may be taken to protect the appropriate party. This may include a medical referral or report to the local law enforcement authorities.
8. At the time a “Little sister” mentee or “Big Sister” Mentor is considered as a match candidate, information is shared between the prospective match parties. The information about the mentor may include such items such as: age, sex, race, religion, interests, hobbies, marital and family status, sexual orientation, living situation, etc. Information about the “Little sister” mentee may include such items such as: age, sex, race, religion, interests, hobbies, family situation, etc.
I agree to program participation under the above conditions. I further agree that I will not share identifying confidential information with anyone outside the agency, including family, friends, or community members, without the written consent of the persons involved (parent/caregiver of a mentee, mentee, or the mentor). I also acknowledge that such information should be shared judiciously even within the ranks of Girl Talk Inc., only with persons who have a specific need to know the information, and only in situations where others would not overhear such communication.