Empowering Independence for All Abilities

First Name:

Last Name:

Home Address:

City:

Zip Code:

Home phone number:

Mobile number:

Email address:

Date available to start:

What position are you applying for?

Front Desk

Projects

Events

Preferred shift times for tutoring between 8am-4pm?

Preferred days for tutoring from Monday – Thursday?

Are you 18 years of age or older?

Under 18

Over 18

Do you have access to a reliable ride?

Yes

Describe any past tutoring or teaching experience.

Describe any relative special skills, interests, strengths.

List any languages you speak other than English.

Free Text

Current Employer’s Name:

Supervisor’s Name and Phone Number:

What was your title?

What type of work did you do?

What dates did you work there?

Why did you leave?

Free Text

Previous Employer’s Name:

Supervisor’s Name and Phone Number:

What was your title?

What type of work did you do?

What dates did you work there?

Why did you leave?

Free Text

Emergency Contact Name and Phone Number:

Do you agree to fingerprinting and a background check?

Yes