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Membership
Mentorship
Events
Contact
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Mentorship Application
Welcome to the WOHSS Mentorship Group! Please complete the entire application to ensure the best match possible.
Mentorship Structure
In what capacity do you wish to participate?
*
As a Mentor
As a Mentee
As both a Mentor and a Mentee
How would you like to meet?
*
In person meetings only
Virtual/telephone meetings only
A combination of in person and virtual meetings
No preference
In person meeting is subject to local health orders, please respect personal comfort levels.
OHS and Industry Experience
Total OHS Experience
*
< 1 year
1-3 years
3-5 years
5-10 years
10-15 years
15-20 years
> 20 years
Within what industry do you prefer your mentor/mentee to have experience?
*
Choose up to 5.
Agriculture/Forestry/Food
Chemical/Allied Products
Communications
Computer/Electrical
Construction
Consulting
Government/Public Sector
Healthcare
Insurance/Risk Management Services
Manufacturing
Mining
Non-profit/Membership Organizations
Oil/Gas/Petrochemical
Services - Retail
Services - Travel/Recreation
Transportation
Utilities
Wholesale/Trade
Other
If Other , please specify.
If Other , please specify.
Within what industry are you currently employed?
*
Agriculture/Forestry/Food
Chemical/Allied Products
Communications
Computer/Electrical
Construction
Consulting
Government/Public Sector
Healthcare
Insurance/Risk Management Services
Manufacturing
Mining
Non-profit/Membership Organizations
Oil/Gas/Petrochemical
Services - Retail
Services - Travel/Recreation
Transportation
Utilities
Wholesale/Trade
Other
Mentorship Preferences
In what functional knowledge competency areas/skills are you wanting to mentor/be mentored?
*
Select all that apply.
Assurance/Compliance
Audits
C-Suite Interactions
Claims Management
Communication and Ethics
Consulting
Education/Professional Training Options
Emergency Planning
Ergonomics/Human Factors
Facilities and Equipment Design/Process Safety
Fire Prevention/Protection
Generalist/Comprehensive
Hazard Analysis
Hazardous Material Management
Healthcare
Incident Investigation/Reconstruction
Industrial/Occupational Hygiene
Inspections
International Safety
Laboratory Safety
Leadership Engagement
Learning & Development, Training Program Design
Legislation/Regulatory
Management Systems and Programs
Material Handling
Medical Services/First Aid
Occupational Health
OHS/HSE Metrics, Reporting and Financial Management
OHS/HSE Strategy
Product Safety
Public Safety
Risk Management
Speaker/Seminar Leader
Team Selection, Building, Retention
Transportation
Workplace Wellness
Other
If other, please specify.
If other, please specify.
What is your main area of expertise?
*
Assurance/Compliance
Audits
C-Suite Interactions
Claims Management
Communication and Ethics
Consulting
Education/Professional Training Options
Emergency Planning
Ergonomics/Human Factors
Facilities and Equipment Design/Process Safety
Fire Prevention/Protection
Generalist/Comprehensive
Hazard Analysis
Hazardous Material Management
Healthcare
Incident Investigation/Reconstruction
Industrial/Occupational Hygiene
Inspections
International Safety
Laboratory Safety
Leadership Engagement
Learning & Development, Training Program Design
Legislation/Regulatory
Management Systems and Programs
Material Handling
Medical Services/First Aid
Occupational Health
OHS/HSE Metrics, Reporting and Financial Management
OHS/HSE Strategy
Product Safety
Public Safety
Risk Management
Speaker/Seminar Leader
Team Selection, Building, Retention
Transportation
Workplace Wellness
In your own words, please describe what you aim to achieve by applying to this Mentorship Program.
*
This could include; why you choose to apply, your relevant experience as a mentor/mentee, what you wish to learn and the skills you wish to develop through formal mentorship or any other professional or personal barriers that you are wishing to overcome.
To help us find the best match for you, tell us what your specific goals are for this mentoring relationship. Knowledge to Gain/Skills to Build/Attitudes to Develop (What must I acquire/improve upon?)
First Goal
Second Goal
Second Goal
Third Goal
Third Goal
In the event WOHSS receives a surplus of mentee applications, would you be willing to:
*
As a Mentor, take on more than one mentee?
As a Mentee, be considered for Peer-to-Peer mentoring?
Neither choice is applicable to me.
Please consider wait times when making your choices! We aim to get you matched with a mentor/mentee as efficiently as possible.
Contact Information/Submission
Please provide us with the contact information that you wish to use for the purposes of Mentorship Committee communications and Mentoring Relationship communication.
Name
*
First
Last
Resident of:
*
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
International
International
If International, please specify:
Email
*
Phone
Please submit your CV/Resume to be used pairing purposes along with this application.
*
Ensure you have an up-to-date and complete resume with your current employment situation, education and certifications.
Drop files here or
Select files
Max. file size: 512 MB, Max. files: 3.
I authorize verification of the accuracy of the information provided on this form.
If accepted, I agree to be governed by the By-laws, Code of Ethics and Code of Conduct of WOHSS, as they are now or may hereafter become.
I consent to WOHSS using my personal information provided in this application for purposes described in the WOHSS
Privacy Policy
.
Consent
*
I agree.
Date
*
MM slash DD slash YYYY
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