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Name Date Address Email Address Phone Number Are you prevented from lawfully becoming employed in this country because of visa or immigration status? YesNo Have you ever been convicted of a felony, or a misdemeanor which resulted in imprisonment? YesNo If 'yes' please explain:
Please list on the following lines all schools attended and any other pertinent information about your education.
1. School Dates Attended Subjects Studied (If Applicable)
2. School Dates Attended Subjects Studied (If Applicable)
3. School Dates Attended Subjects Studied (If Applicable)
Please start with most current employer.
Are you employed at the present time? YesNo Employer’s Name Employer’s Address How long have you been with this employer? May we contact this employer? YesNo
1. Previous Employer Employer’s Name Employer’s Address How long were you employed with this employer? May we contact this employer? YesNo
2. Previous Employer Employer’s Name Employer’s Address How long were you employed with this employer? May we contact this employer? YesNo
Have you ever been dismissed, or asked to resign from any position? YesNo
MacPC
Please provide computer and software knowledge below:
Do you have access to a reliable vehicle? YesNo
SAT Score:
ACT Score:
Please describe your past teaching and/or tutoring experience:
Subject areas:
Activities:
1. Name Address Phone Number Relationship:
2. Name Address Phone Number Relationship:
3. Name Address Phone Number Relationship:
I certify that all statements made herein and on the enclosed resume are true and correct to the best of my knowledge. I authorize investigation of all statements herein recorded. I release from liability all persons and organizations reporting information required by this application.
Electronic Signature (Your Name) Date
