PSHRA- NC Mentor Application

* Mentor Name: First and Last Name

Mentor Title Job Title

* Mentor Organization

Preferred contact information

* Phone Number:

* Email:

* Are you comfortable using virtual technology for meetings/mentoring?

If yes, what platforms are you comfortable using?

Traditional Phone Calls
Google Meet
Microsoft Teams
Zoom
Facetime
Google Duo
Email
Mobile Text

* How many years of Human Resources experience do you have?

* How many years of HR Public Sector experience do you have?

* Do you have HR Supervisory/Managerial experience?

If yes, how many years?

List any current professional certification (IPMA, SHRM, HRCI, etc.) you have?

I am an active NC PSHRA member, and will participate as a mentor for a minimum of one(1) year. I agree to releasing my contact information to the mentorship committee. By signing below (entering your first and last name) I affirm that the above information is true to the best of my knowledge.

* Signature Name and Date (mm/dd/yyyy)

Members Log In
PSHRA North Carolina Chapter ID:

Password:

	Forgot Username/Password?