Mentor Registration

Personal Information

First Name *

Last Name *

Preferred name to be used in Careersa mentorship program

LinkedIn Profile Link

Mentorship Fee

My hourly rate for mentorship: *

Contact Information

Home address

City *

Province/state *

Country *

Email *

Confirm email *

Password *

Confirm password *

Postal code *

Phone number

Employment Information

Employment Status: *

Employed

Self employed

Retired

Unemployed

Employer Information (if employed):

Employer Name *

My position *

Employer Website

Document Upload

Resume *

Upload your latest resume or drop here

Accepted formats: PDF, DOC, DOCX
Max size: 5 MB.

Headshot *

Upload your headshot or drop here

Accepted formats: JPG, PNG — Max size: 3 MB.
This photo will appear on your public mentor profile.

Disclosure & Agreement

I understand that the information I have supplied on this form will be used solely for the purpose of administering the mentorship program.The information is collected in accordance with the mandate of the program.

This information may be used to verify my eligibility and to facilitate appropriate matching with mentees. It will be stored securely and handled in accordance with applicable privacy and data protection standards.

I Acknowledge that my information will not be shared with any external parties unless i have given explicit authorization to do so.

I understand that my registration is subject to approval by the program administrator.

I have read and agree to the Mentor Declaration.