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A1 TUTORS Please complete the following as fully as possible; TITLE; Mr./Mrs./Miss./Ms./Dr./Other NAME: ..................................................................................................................................................................... ADDRESS: ............................................................................................................................................................. IF THE ABOVE ADDRESS IS TEMPORARY, WHEN DO YOU EXPECT TO LEAVE? .............................. ................................................................................................................................................................................... MALE / FEMALE (Please circle) MAIDEN NAME ............................................................................................. PREVIOUS/OTHER NAMES (if known) .............................................................................................................. TELEPHONE NO. (EVENINGS) .................................................................... (DAYTIME) ........................................................................................................ EMAIL ................................................................................................................ DATE OF BIRTH .............................................................................................. PLACE OF BIRTH ........................................................................................... NATIONALITY .................................................... MOTHER TONGUE ................................................................. LENGTH OF TIME RESIDENT IN UK .................................................................................................................. CURRENT EMPLOYMENT ................................................................................................................................... UNEMPLOYED [ ] HOUSEWIFE [ ] SUBJECTS OFFERED 1 ................................(LEVEL)...................... Qualification (where obtained/year) ............................................ 2 ................................(LEVEL)...................... Qualification (where obtained/year) ............................................ 3 ................................(LEVEL)...................... Qualification (where obtained/year) ............................................ TEACHING EXPERIENCE (IF ANY) PLEASE GIVE DATES AND LOCATIONS: ................................................................................................................................................................................... ................................................................................................................................................................................... STATE ANY OTHER RELEVANT EXPERIENCE: ............................................................................................ ................................................................................................................................................................................... ................................................................................................................................................................................... ARE YOU PREPARED TO TRAVEL TO THE STUDENT'S HOME ? YES/NO (Please delete as applicable). IF YES, HOW FAR ARE YOU PREPARED TO TRAVEL? ............................................................................... DO YOU HAVE YOUR OWN TRANSPORT? ....................................................................... DO YOU HOLD A CURRENT DRIVING LICENCE? ........................................................... ARE YOU PREPARED TO TEACH IN YOUR OWN HOME?............................................. UNQUALIFIED OR INEXPERIENCED TEACHERS: DO YOU WISH TO ATTEND A HALF-DAY TRAINING WORKSHOP? YES/NO (Delete as applicable) COST £60.00 PER PERSON AS MANY OF OUR STUDENTS ARE CHILDREN WE ARE OBLIGED BY LAW TO ASK THE FOLLOWING QUESTIONS: HAVE YOU HAD ANY CRIMINAL CONVICTIONS? YES [ ] NO [ ] YOU MUST DISCLOSE ANY SPENT OR PENDING CONVICTIONS (THIS IS A LEGAL REQUIREMENT.) IF YES, PLEASE GIVE FULL DETAILS.............................................................................................................. .................................................................................................................................................................................. .................................................................................................................................................................................. DO YOU HAVE ANY OBJECTIONS TO OUR HAVING ACCESS TO ANY POLICE RECORDS WHICH MAY BE HELD IN YOUR NAME? YES [ ] NO [ ] IF YES, PLEASE STATE YOUR REASONS ..................................................................................................... .................................................................................................................................................................................. PLEASE GIVE BELOW THE NAMES, ADDRESSES AND TELEPHONE NUMBERS OF TWO PEOPLE WHO COULD PROVIDE CHARACTER REFERENCES: (These must be previous or present employers, tutees, or college lecturers under whom you have studied.) 1) NAME .................................................................................................................................................................. ADDRESS .............................................................................................................................................................. ................................................................................................................................................................................... TELEPHONE NO ................................................................................................................................................... IN WHAT CAPACITY DO YOU KNOW THIS PERSON?................................................................................... 2) NAME .................................................................................................................................................................. ADDRESS .............................................................................................................................................................. ................................................................................................................................................................................... TELEPHONE NO ................................................................................................................................................... IN WHAT CAPACITY DO YOU KNOW THIS PERSON?................................................................................... Please sign the following: I AGREE TO INFORM A1 TUTORS OF LESSONS TAKEN WITH EVERY STUDENT INTRODUCED TO ME BY A1 TUTORS AND TO FORWARD ALL FEES DUE TO A1 TUTORS WITHIN SEVEN DAYS OF COMPLETION OF EACH CALENDAR MONTH. I ALSO AGREE NOT TO MAKE A SEPARATE ARRANGEMENT WITH ANY STUDENT INTRODUCED TO ME BY A1 TUTORS BY WHICH ANY PAYMENTS WOULD BE MADE ENTIRELY TO ME, THEREBY DEPRIVING THE AGENCY OF THE COMMISSION DUE TO IT. I HAVE READ THE INFORMATION SHEET ('Become A Tutor' page, 'Frequently Asked Questions') AND, SHOULD I BE ACCEPTED BY A1 TUTORS AS A TUTOR , I AGREE TO ABIDE BY THE TERMS SPECIFIED Signature .............................................................. Date ...................................................................... Please enclose two first class stamps for your referees, and send your application to; A1 Tutors, 22 Canterbury Rd., Flitwick, Beds. MK45 1TZ IMPORTANT Have you enclosed:- 1) Proof of identification 2) Copies of any certificates held. 3) Either a current (not more than three years old) CRB disclosure or a cheque payable to A1 Tutors for £45.99 4) Names and addresses of two referees (these must be past or present employers, private students you have taught, or lecturers under whom you have studied.) 5) Two first class stamps for your referees. 6) A copy of your work permit if you are a non E.U. citizen Failure to enclose the above will result in your application being rejected. Top of Form |