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Student Tutoring Job Application

Applicant Information

Full Name: Date: Last First M.I.

Address: Street Address Apartment/Unit #

City State ZIP Code

Home Phone: Email:

Parent Phone: Mobile Phone:

Preferred Tutoring Subject:

When are you available to tutor?

Have you had any disciplinary issues while in high school? YES NO

If yes, please explain:

Are you bilingual? YES NO

If yes, please list languages other than English, and indicate your speaking, reading and writing skill for each:

Are you interested in tutoring in another language? YES NO

If yes, what language:

Previous Employment or Volunteer Experience

Company: Phone:

Address: Supervisor:

Job Title: Hourly Rate: $

Responsibilities:

From: To: Reason for Leaving:

Tues Weds Thurs 2pm – 3pm 3pm – 4pm

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May we contact your previous supervisor for a reference? YES NO

Company: Phone:

Address: Supervisor:

Job Title: Hourly Rate: $

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference? YES NO

Company: Phone:

Address: Supervisor:

Job Title: Hourly Rate: $

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference? YES NO

Disclaimer and Signature I understand and agree that any false statements by me on this application will be sufficient cause for withdrawal of this application and/or separation from the Student Tutoring service if I have been employed.

I hereby certify that

• all information given by me on this application is true and complete to the best of my knowledge

• all questions relating to me have been accurately and fully answered

• I possess all the qualifications which I claim to hold

Signature: Date: