Page 1 of 2

PI form mentee

First name

Last name

Gender

How did you hear about DUO for a JOB?

Answer not visible in the mentee note

Heard about DUO via

Please refer to this page to encode provenances levels 1, 2 and 3 correctly.

Date of birth

Phone number

Email

Address (street and number)

Postal code

City

Location(s)

If relevant

Country of birth

According to official issued ID

Country of origin

Nationality

Which languages can you speak?

Encode mentoring languages in priority (= MT or C level). Add at least Dutch, English and French.

Migration history

If relevant and if the mentee is comfortable talking about it

Arrival date

Only if mentee was not born here

1st residence permit date - FR

Type of ID card

Current reason for residence

Only answer this question if the mentee does not have the nationality of a EU country

Former UASC ?

BE (🇧🇪) MENA / NBMV - FR (🇫🇷) ASE / MNA - NL (🇳🇱) AMV

ID number

Belgium : use the National Registration Number

France : use the NIR (Numéro d’Inscription au Répertoire - sur la carte vitale)

ID card valid for at least another two months?

Yes

Additional info about ID card

Récépissé? Access to the job market?

Remember to make copy of ID card if needed

Actiris number - BE

Obligatoire pour Bruxelles et Wallonie. N'oubliez pas de demander l'attestation de périodes d’inscription au Forem et de la sauvegarder dans le CRM

Marital status

Children ?

Yes

How many ?

What ages ?

Childcare situation

Childcare issue ?

Yes

Additional info about childcare issue ?

Housing situation

Housing issue ?

Yes

Type of problem

Additional info about housing

Source of income

Registered as a job seeker with

France Travail agency

Only for Île-de-France antenna

Are there other organisations supporting you ? Any person in particular ?

Note down contact person's details if shared with you

What are your means of transportation ?

Additional info about means of transportation

How much does it cost, do you have insurance, is it your car or do you borrow it, do you have a transportation subscription, do you have any particular difficulties with mobility...?

Valid driver's licence ?

Yes

School career

How many years, until which age, certificates (here or elsewhere)

Additional training or ongoing courses

Literacy ?

This question is related to the mother tongue

Literacy ?

Yes

What is your highest diploma (here or abroad) ?

Highest obtained degree, regardless of place of issuance or recognition by local authorities

What is your highest level of diploma recognised here ?

Highest obtained degree, regardless of place of issuance or recognition by local authorities

Professional career

Recognised or not, internship, student job, temporary work, volunteering (here or elsewhere)

Do you have a specific desire professionally ? A sector you are interested in ? A job you would like to do ? Why so ?

Short-term / Long-term

Are there trainings you would like to take part in ?

Assess the job search : How long have you been looking ? Do you have a CV, a cover letter, LinkedIn ? What are the steps you have already taken ?

Able to use the internet ?

Yes

Able to use a computer ?

Yes

Able to use Word ?

Yes

Any specific programs you know ?

Only if relevant for the job search (eg. web developer, graphic designer...)

Access to internet at home ?

Yes

Access to a computer at home ?

Yes

Need for a Chromebook ?

Yes

What are the main difficulties you encounter in your job search ?

Take some time to ask this question in a very practical and down to earth way. The capacity to formulate difficulties is dependent on one's comprehension of their environment.

Why do you want to take part in the program ?

Test the expectations and redefine if needed

What are your main expectations from the programme ?

Click here to view a translation in Dutch and French for screen sharing with the mentee : https://docs.google.com/forms/d/e/1FAIpQLSelNEi0veGJA6xdK6CSPsSY3krQvhrMSvO84JnOden4hKRqlQ/viewform

What would the 'ideal' mentor be like, according to you (sector, personality, languages, ...) ?

How would you describe yourself in a few words ?

What do you enjoy doing in your free time ?

Availability during the week

Are you ok to be accompanied on site (IRL) by a mentor ?

Yes

Are you ok to be accompanied remotely by a mentor, which mainly means by video conference ?

Yes

Relevant information about digital participation

Availability for matching ? If not ASAP, enter a date and the person will be frozen until then

Be clear with the timing, according to the number of available M

Additional info about availability for matching

ICE contact name and relationship

ICE contact phone number with international prefix

Thanks! Anything you would like to add or ask ? Any blocking factors ?

Backend admin

Language of the interview

Professional experience abroad

Yes

Length of experience abroad if any ?

If professional experience abroad - is it relevant for current project ?

Yes

Professional experience in residence country

Yes

Length of domestic experience if any ?

If experience in residence country - is it relevant for current project ?

Yes

Target sector 1

Target sector 2

Target sector 3

Ideal mentor (according to MPO)

Mentee's personality (according to MPO)

Points of attention

MPO must be present when matching this profile ?

Yes