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Mentee Application

[Download editable version of this form.]
Name: Today’s Date: 
Title: Agency: 
Office Mailing Address: 
Office Phone Number: Office Email Address: 
Current Occupational Series: 
Current Series/Grade: Length of Government Service: 
I Am a Supervisor/Manager (Y/N): 


Background Information:

1. Why do you want to work with a mentor? (500 characters max):



2. What do you consider to be your strongest competencies?(600 characters max):



3. Which competencies you would like to develop by working with a mentor? (1000 characters max):



4. What are your interests or hobbies outside of work? (600 characters max):



5. Do you have someone in mind who you would like to suggest as your mentor? (the program manager will confirm the requested mentor as a suitable match, his/her availability and participation interest.  there are no guarantees you will be paired with this individual)





Mentee signature: ____________________________________________________

Supervisor signature: ____________________________________________________

By signing the application you acknowledge the employee above can participate in the Mentor Program.


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