Please fill out the form below, or click on link to open PDF file: Suzi Feldman Tutor Application pdf
Tutor Application
(print out form, fill out and email to: sfeldman1@san.rr.com)
First Name:
Last Name:
State:
City:
Street address:
ZIP Code:
Number of years at Address:
Previous State (if applicable):
Previous City (if applicable):
Previous Street (if applicable):
Previous Zip (if applicable):
Email:
Cell Phone:
Home Phone:
Work Phone:
Subjects you are qualified to tutor (please circle)
| Basic Math
Pre-Algebra Algebra I Algebra II Geometry Trigonometry Math Analysis Pre Calculus Calculus I Calculus II Statistics Biology AP Biology Microbiology Physiology Physics Chemistry – inorganic Chemistry – organic Chinese Test Prep ACT PSAT SAT CAHSEE ISEE HSPT |
English – middle
English high School AP English Writing US History European History World History Art history Economics Government ESL Chinese French German Hebrew Japanese Latin Spanish Sign Language Study Strategies Organizational Skills |
Grade level(s) you are qualified to tutor (please circle)
| K-5
6-8 9-12 College |
Other subjects you can tutor?
Experience with learning disabilities? What kinds?
Years tutoring:
Years teaching:
Do you have a State Teaching Credential or Teaching License?
(i.e. EC-6 Generalist, Secondary Mathematics)
(please choose)
Yes
No
If yes, What type?
Education:
School Attended:
Days available:
Please provide an overview of your previous teaching or tutoring experience.
What other skills or experiences do you feel would qualify you for employment with Specialized Learning?
Why do you want to work for Specialized Learning?
How many hours per week can you tutor?
Do you have your own car?
How often do you check your email?
Are you willing to drive up to 20 minutes for tutoring assignments?
(please choose)
Yes
No
How long will you reside at your current address?
If you move will you stay in the same city?
(please choose)
Yes
No
Do you have a valid driver’s license?
(please choose)
Yes
No
Do you have a criminal record (felonies)?
(please choose)
Yes
No
Are you able at the time of employment, to submit verification of your legal right to work in the U.S.?
(please choose)
Yes
No
Education
Undergraduate Education
Degree(s) Attained:
University Attended:
Did you graduate?
(please choose)
Yes
No
In Progress
Year Completed
Postgraduate Education
Degree(s) Attained:
University Attended:
Did you graduate?
(please choose)
Yes
No
In Progress
Year Completed:
Job History (most recent first)
Job 1
Employer’s Name:
Employer’s Street:
Employer’s City:
Employer’s State:
Title/Duties:
Employment Dates (start to end):
Reason for leaving:
Name of Supervisor:
Supervisor’s Email:
Supervisor’s Phone:
May we contact him/her?
(please choose)
Yes
No
Job 2
Employer’s Name:
Employer’s Street:
Employer’s City:
Employer’s State:
Title/Duties
Employment Dates (start to end):
Reason for leaving:
Name of Supervisor:
Supervisor’s Email:
Supervisor’s Phone:
May we contact him/her?
(please choose)
Yes
No
Job 3
Employer’s Name:
Employer’s Street:
Employer’s City:
Employer’s State:
Title/Duties:
Employment Dates (start to end):
Reason for leaving:
Name of Supervisor:
Supervisor’s Email:
Supervisor’s Phone:
May we contact him/her?
(please choose)
Yes
No
