MENTORING PROGRAM

REGISTRATION & TRAINING CERTIFICATION

This document must be completed for volunteer service with each organization.

Please type or print

Associate Information:

Name: ________________________________ Social Security #: ____________________

Employment Status (please ( one)

□ Career Service	□ Select Exempt Service	□ Senior Management Service

Division/Bureau/Section:______________________________________________________

Cost Center #: _____________Work #: (_____)_______________ Suncom #: ________

Fax #: (_____)____________________ E-mail: ____________________________________

Mailing Address: ______________________________________________________________

______________________________________________________________________________

________________________________________	______________________________

Associate’s Signature	Date

II.	Supervisor Information:

Name: ________________________________________ Work #: (____)________________

Fax #: (______)_________________________ Suncom #: __________________________

I do / do not (circle one) give authorization for_______________________________________ (associate’s name) to participate in the Mentoring Program.

_________________________________	______________________________

Supervisor’s Signature	Date

Training/Orientation Certification (must be completed by Organization):

Name of Organization: _______________________________________________________

Mailing Address: ____________________________________________________________

Phone Number: ________________________ Fax Number: (____) ___________________

E-mail Address and/or Web Page: ______________________________________________

Contact Person: _______________________________________________________________

Brief Description of your Organization: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What type of service will our associate be performing for your Organization? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Did our associate complete your Organization’s training or orientation? ___________

Date of Completion: __________________________________________________________

Mentoring Coordinator Use Only

DEO Registration Date: __________________________

Reviewed by: __________________________________

(please print)

Signature:	__________________________________

Mail all correspondence to:

Department of Economic Opportunity – Human Resources

Attn: Louise Mondragon

107 East Madison Street, Caldwell Building

Tallahassee, FL 32399-4122

MENTORING PROGRAM REGISTRATION

PROCEDURES

COMPLETING THE PAPER WORK

All steps must be completed before participating in the Mentoring Program.

Contact your Supervisor.

You must inform your supervisor of your interest in participating in the department’s Mentoring Program. Your supervisor must give approval before participation begins.

Included in your packet are:

DEO Form MP-1

Part I: Associate Information. This section requires information about the associate.

Part II: Supervisor Information. Your Supervisor must complete this portion entirely.

Supervisor’s approval must be given before going to the next step.

Part III: Training Certification. The organization’s coordinator will complete this section	of the form.

DEO Form HRM-57

Volunteer Certification for Administrative Leave. Follow instructions on the reverse side of this form. An additional copy of the DEO Form HRM-57 is in your packet. Duplicate for further use.

An informational pamphlet about the department’s Mentoring Program. This flyer is to be provided to the organization.

Slow down!

You can’t start your service yet!

Contact an area organization of your interest. Speak with the organization’s coordinator to schedule your training or orientation. Notify your supervisor of the date and time by submitting your official time sheet to your supervisor for approval.

Bring all forms to your training or orientation and give them to the organization’s coordinator for completion. Review the forms for completeness after receipt from the coordinator. If not completed properly, the forms will be returned to you for completion. Remember that this will delay your participation.

Registration /Training Certification

Check (() when you have completed each portion of the

Registration and Training Certification

(	Part I	Associate’s Information

(	Part II	Supervisor’s Information

(	Part III	Training Certification

Mail original DEO Form MP-1 to the agency’s mentoring coordinator. Provide a copy to your supervisor.

Participation may begin!

(	You will receive a copy of the original registration form signed by the coordinator for your records.

DEO FORM/MP-1 (11-2000)

Associate Information

OSAS

2002-08-22

mcgillj

FDLES/OSAS