STEM Program InstructorApplication Form

STEM Program InstructorApplication Form
I am applying for

Program Instructor
Full Name*

First NameLast Name
Former Name (maiden or married)

First NameLast Name
Former Name (maiden or married)

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail Address*
Phone Number

STD CodePhone Number
Mobile*
Male/Female

MaleFemale
Birth Date

MonthDayYear
Nationality
Job reference No.
Only if applicable
How did you hear about us?
When can you start working for us
What skills do you bring to Nyla Nova STEMversity?
Please enter the age groups you are willing to work with or write curriculum for:
Hold CTRL for multiple selections
If you have taught a lesson before, tell us about it here.
Please list the subjects and levels you can teach, these are those you would be expected to teach. Please list any courses that you would like to teach as an enrichment course like personal finance, fitness, knitting, etc..
Subject No 1
Subject No 2
Subject No 3
Subject No 4
Do you have A Diploma?

YesNo
Please list in which state
Do you have A Degree?

YesNo
Please list in which state, name of university and degree information
Do you have a Teacher Qualification License?

YesNo
Please list in which state and what licensed areas
Are you working towards a Teaching Qualification License?

YesNo
Do you have at least 12 college credits or is currently enrolled in a teacher preparation program?
Do you have any other qualifications?
Do you agree to have a background check?

YesNo
Confirm you are eligible to work in the US

YesNo
Do you have a criminal prosecution pending?

YesNo
If yes please tell us about it here.
Do you prefer to just teach online only?
How far would you travel to teach a class?
If you are applying for a curriculum writer this will not apply for you. You can leave it blank.
Do you have a driving license?

YesNo
Area of Indianapolis that you wish to be assigned to work
If you are applying for a curriculum writer this will not apply for you. You can leave it blank
Do you have access to a vehicle?
If you are applying for a curriculum writer this will not apply for you. You can leave it blank
Which days are you able to teach?
Hold CTRL for multiple selections
Which times are you available.
Hold CTRL for multiple selections
Are you currently employed?

YesNo
Are you a full time student?

YesNo
Please tell us of any special skills you may have. Do you like working with children?
Have you worked with children with physical or emotional disabilities?

YesNo
Please tell us a little more about yourself, what motivates you, your passions and plans. To help us make this match give us some idea of your interests, hobbies etc.
First reference
Please provide the names of two organizations or professionals we can use as references. (These cannot be family or friends)
Name*
Telephone
Email*
Profession/Relationship
Second reference
Name*
Telephone
Email*
Profession/Relationship
Browse you computer or network to upload your CV/Resume'
Upload your CV/Resume'

Upload a File

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Browse you computer or network to upload a copy of your teacher's license
Upload your copy of your teacher's license

Upload a File

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Browse your computer or network to upload a copy of college transcript( it can be unofficial) or high school diploma
Upload your copy of your college transcript or high school diploma

Upload a File

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Browse your computer or network to upload your Profile Picture (Please make sure this is a professional headshot because it will be used for advertising)
Upload your Picture

Upload a File
Optional Cancelof
Browse your computer or network to upload your biography or information that we can share with our students and parents. This also will be used for advertising.
Upload your BIO

Upload a File

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Shirt Size for Uniform*

SmallMediumLargeX-LargeXX-LargeXXX-Large
Do you know anyone else that would be a great instructor or curriculum writer for Nyla Nova STEMversity?
Name
Email
example@example.com
Phone Number

Area CodePhone Number
Do you have any relatives that currently work for or previous work for Nyla Nova STEMversity? If so please name them.*
Emergency Contact

Please provide information of someone we can contact just in case of emergency
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Relationship *
Do you understand that you will be an independent contractor and we can't guarantee that you will make money? Do you understand that student availability and your ability to connect with students will determine how much money that you will make?

I understand and agreeI do not wish to sign up to be a instructor
Do you understand that you will be required to participate in mandatory trainings and you will be a representative of Nyla Nova STEMversity and must adhere to the highest standards?

I understand and agreeI do not wish to sign up to be a instructor
While you may or may not know that your students may have some form of a disability, you must not ask that your students disclose their disability to you. It is up to the student to decide whether they want to disclose information about their disability to you. Please speak with your academic coach about any concerns that you may have about your student. Your academic coach will be able to discuss your student’s background with you. Additionally, do not share information about your students to people outside of Nyla Nova STEMversity. If you have questions about this policy, or if at any point you are unsure of what constitutes a need-to-know basis, please contact your Lead Instructor for clarification. You must adhere to private and nondisclosure policies of the student and Nyla Nova STEMversity.

I understand and I agreeI do not agree
Do you understand that you are required to take a background check, drug screening and get CPR certified before you will be scheduled classes?

I understand and agreeI do not agree
I understand that I am a valuable part of the faculty and I am willing to make a 3-month and/or 90 day commitment or more.

I totally agreeI do not agree
Signature

Clear
Please contact us if you have any questions:

NylaNovaSTEM.com Mobile: (317)910-2559 Email: Info@NylaNovaSTEM.com
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STEM Program InstructorApplication Form

Emergency Contact

Please contact us if you have any questions: