Good Morning
Registration
Personal Profile
User Name (Use your SSA emal address)
Email
First Name
Last Name
Password
I would like to participate as
Mentor
Mentee
Preferred Telephone Number
Area Code
Phone Number
Gender Identity
Pronoun
Let us know what type of mentoring you would like to participate in.
1 to 1 Mentoring
Small Group Mentoring
Either
Both
Which of the following most appropriately reflects your race? (These categories are based on the U.S. Census Bureau)
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Two or More Races
Decline to answer
Other
If you chose other, please specify your race here.
Which of the following most appropriately reflects your ethnicity? (These categories are based on the U.S. Census Bureau)
Hispanic or Latino
Not Hispanic or Latino
Decline to answer
Other
If you chose other, please list your ethnicity here.
Years with the County
<1
1-4
5-9
10-19
20+
Job Title
Years in your current position
<1
1-4
5-9
10-19
20+
Job Level
Executive
Manager
Supervisor
Worker
Clerical
Department
Agency Office
Dept. of Aging and Adult Services
Dept. of Employment and Benefit Services
Dept. of Family and Children's Services
VSO
TSS
Learning Organization/Wellness
Office of the County Executive (CEO)
Other
Please enter department name if you selected Other.
What department would you like to be matched with? (First Choice)
Agency Office
Dept. of Aging and Adult Services
Dept. of Employment and Benefit Services
Dept. of Family and Children's Services
Office Veterans Services
Technology Services and Solutions
Learning Organization/Wellness
Office of the Executive (CEO)
Any department
What department would you like to be matched with? (Second Choice)
Agency Office
Dept. of Aging and Adult Services
Dept. of Employment and Benefit Services
Dept. of Family and Children's Services
Office Veterans Services
Technology Services and Solutions
Learning Organization/Wellness
Office of the Executive (CEO)
Any department
What department would you like to be matched with? (Third Choice)
Agency Office
Dept. of Aging and Adult Services
Dept. of Employment and Benefit Services
Dept. of Family and Children's Services
Office Veterans Services
Technology Services and Solutions
Learning Organization/Wellness
Office of the Executive (CEO)
Any department
Biography
Location
650 S. Bascom Ave
2300 Enborg Lane
2232 N. First Street
90 Highland Ave
333 W. Julian Street
373 W. Julian Street
591 N. King Road
1330 Middlefield Road
725 E. Santa Clara Street
1867 Senter Road
1870 Senter Road
1877 Senter Road
1879 Senter Road
353 W. Julian Street
1919 Senter Road
379 Tomkins Court
7933 Wren Ave
400 Race Street
68 N. Winchester Bld.
70 W. Hedding Street
Other
Please enter location if you selected Other.
Anything further you would like to share privately with the Program Administrators?
Do you have your supervisor's approval to participate in the SSA Mentoring Program?
Yes
No
What is your supervisor's name?