FAME

Business Mentor Application Form

Would you like to become a business mentor? Please fill in this form and you will receive a response by email in a few days. All fields are required. Your application is treated as strictly confidential.

* = required field

First name:

Last name:

Company name:

E-mail address:

Home phone:

Mobile phone:

Postal address:

Work phone:

Work fax:

Physical address:

Gender:

Please select the categories which best defines your industry experience and describe the business activity with which you are most familiar.*

	Personal and Other Services	Accommodation, Cafes and Restaurants
	Cultural and Recreational Services	Retail Trade
	Health and Community Services	WholesaleTrade
	Education	Construction
	Government Administration and Defense	Electricity, Gas and Water Supply
	Property and Business Services	Manufacturing
	Finance and Insurance	Mining
	Communication Services	Agriculture, Horticulture, Forestry and Fishing
	Transport and Storage	Not for Profit
Other Industry:

Your business activity in more detail:*

Please select the category/categories of expertise which best describe your business skills. *

Strategic/Business Planning
Human Resource Management
Finance and Accounting
Sales and Marketing
IT & Communications

Process Management
Importing/Exporting
Legal/Compliance
Not for Profit
Other Skill:

What factors do you think contribute most to your success in business?*

Briefly list your work history. *

Are you aware of any other factors such as personal insolvency, involvement in an insolvent company or criminal convictions which are relevant to your suitability to act as a mentor? *
Yes No

Why are you interested in being a mentor? *

Please enter the names of two references who we can contact by phone.

Reference 1 name:

Reference 1 phone:

Reference 2 name:

Reference 2 phone:

* By clicking the Submit button, you confirm that the information contained in this application is accurate and that it may be checked by SUN&SUP / CICOM.

Click submit to submit your application. You may also contact us on +33 (0)4 93 00 60 11 for any reason regarding your application, we welcome your enquiries.