Are you interested in Teaching for Study Smart? Fill out this simple form and we will get back to you.

Name

Date

Address

Email Address

Phone Number

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?
YesNo
If 'yes' please explain:

Education

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)

Employment Information

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

Computer Skills

MacPC

Please provide computer and software knowledge below:

Computer Skills

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:

References

1. Name

Address

Phone Number

Relationship:

2. Name

Address

Phone Number

Relationship:

3. Name

Address

Phone Number

Relationship:

Upload Your Resume

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