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Tutor Application
By checking the box below, I understand and acknowledge that I am submitting an application for employment, and that I may be subjected to a credit and background check as a condition of employment. However, I am assured that my information is confidential, is never shared, and is only used for the purpose of pre-qualifying me as a prospective teacher/tutor for the Waiting To Excel Tutoring Program.
Personal Information (* indicates optional information)
Name: DOB (mm/dd/yyy)
Country: State:
City/Providence: County:
Street Address:
Primary Phone: Alternate Phone:
Email:
Emergency Contact: Phone:
*Occupation: *Martial Status: *Race:
Education
Highest Grade Completed (plese check one):
PhD MA BA AA College GED 12 11 10 9 8
Field of Study: Degree Received (mm/yy):
Last School Attended:
Location:
Preferred Subjects
What subject(s) or area(s) of study would you like to tutor?
Basic Math Reading Writing History Literature Health Science
Geography Social Studies Language Arts HumanitiesReligion
Algebra Geometry Physics Statistics Probability Calculus
GEDESLComputersTest-TakingNote-TakingCollege Prep
Foreign Language(s): Business/Accounting
MS WordMS ExcelMS PowerPointMS AccessMS Publisher
Preferred Grade Levels
I feel most comfortable tutoring (please check all that apply):
PreK-3 4-6 7-8 9-12 ABE LEP LD College
Teaching/Tutoring Experience & Background
No. of total years teaching/tutoring: Dates:
Subjects:
Last School/Organization:
Address:
Teaching/Tutoring Certification(s) - Include certifying organization and expiration dates:
Professional Memberships, Awards, or Offices Held:
Computer Software/Hardware Knowledge or Certification(s):
Other Special Skills/Knowledge/Languages Spoke other than English:
Referral
How did you hear about the Waiing To Excel Tutoring Program?
Flyer Newspaper Newsletter Radio TV Web Search
Elementary School Junior High School High School Charter School
Direct Mail Email Church Community Org Relative/Friend
Self Certification
I certify that, if need be, I would qualify for a fingerprint card
I certify that, if need be, I would pass a background check
I certify that the foregoing information I have provided is true and correct to the best of my knowledge. I understand that if I have falsified any information, I will be immediately disqualified as a candidate for employment with the Waiting To Excel Tutoring Program and any of its affilitate programs and organizations
Please contact me by: Email Telephone Postal Mail
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