Application Form - Restorative Justice Facilitators

Section 1: Application Information (Step 1 of 6)

Surname (Last Name)*

First Name*

Middle Name

Are you a Justice Peace?*

Yes No

If Yes. What is your Seal No. #

Are you a Marriage Officer?*

Yes No

Alias or other Name

Title*

Mr. Mrs. Miss Reverend Dr.

Date of Birth*

Gender*

Male Female

Home Address*

City/Town*

Parish*

Home Phone

Mobile Phone*

Work Phone

Email*

Have you ever been convicted of a criminal offense?*

Yes No

If Yes. Please provide explanation

Section 2: Educational Background (Step 2 of 6)

Highest Degree Obtained*

Primary School High School Some College/University Graduate/Professional Degree Doctorate

Section 3: Employment History (Step 3 of 6)

Date Employed (most recent position)

From:*

To: (Leave blank if currently employed)

Name of Employer/Organisation Name and Address*

Name of Supervisor*

Telephone Number*

Position and Major Duties*

Currently Unemployed?*

Yes No

Reason for Leaving

I am currently Retired*

Yes No

Section 4: Voluntary/Community Experience (Step 4 of 6)

Name of Organisation/Entity or Community and Address*

Date

From:*

To: (Leave blank if currently a volunteer)

Name of Contact Person*

Telephone Number*

Describe the service that you gave, including any major tasks or accomplishments.*

Section 5: Work Preferences (Step 5 of 6)

This section will allow you to give us information that will help us know how to schedule your service.

Do you have any physical disabilities that we might need to make special arrangements to accommodate?*

Yes No

If Yes. Please describe them

Please Upload Headshot Photo(jpg/jpeg/png)(Max. File Size 1MB)*

Upload Your Resume (pdf)(Max. File Size 1MB)*

Section 6: Reference Information (Step 6 of 6)

Please detail the contact information of three (3) Character References. References may be a Justice of the Peace, Minister of Religion, Inspector of Police (include division), Attorney-at-law, School Principal or Lecturer.

Surname (Last Name)*

First Name*

Middle Name

Position*

Relationship to you

Work/ Home or Mailing Address

City/Town

Parish

Home Phone

Mobile Phone*

Work Phone

Fax Number

Email Address*

Other Email Address

Surname (Last Name)*

First Name*

Middle Name

Position*

Relationship to you

Work/ Home or Mailing Address

City/Town

Parish

Home Phone

Mobile Phone*

Work Phone

Fax Number

Email Address*

Other Email Address

Surname (Last Name)*

First Name*

Middle Name

Position*

Relationship to you

Work/ Home or Mailing Address

City/Town

Parish

Home Phone

Mobile Phone*

Work Phone

Fax Number

Email Address*

Other Email Address

Terms and Conditions

I accept the invitation to volunteer my services as a Restorative Justice Facilitator and certify that the information contained in this application form is accurate and complete. I pledge that in my work with the Restorative Justice Programme, I will not divulge or discuss any matter relating to either the victim or the offender or any other information of a sensitive or confidential nature. I am willing to accept advanced training in Restorative Justice. I also consent for the Ministry of Justice to acquire a Police Record.

I understand that if my conduct and/or behavior brings the Restorative Justice programme into disrepute I will be immediately asked to exit the program.

I Agree with the terms and conditions*

Application Form - Restorative Justice Facilitators

Complete this form in 6 steps!