EVTS VR Application

Elite Vocational & Tutoring Services
APPLICATION FOR EMPLOYMENT
Date

MonthDayYear
Date
Name*

First NameLast Name
MI
Maiden Name if applicable
Social Security No
Date of Birth*

MonthDayYear
Date
Address*

Mailing Address and Physical

Street Address Line 2

CityState / Province

Postal / Zip Code
City
Zip Code
Email*
example@example.com
Phone Number*
Format: (000) 000-0000.
AVAILABILITY
Date Available to Start

MonthDayYear
Date
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Desired Hourly Rate
Are you a citizen of the United States?*

YesNo
If you are not a U.S. citizen, are you authorized to work in the United States?*

YesNo
Have you ever been convicted of a felony/misdemeanor?*

YesNo
If yes explain
Are you fluent in any language besides English Please list:
Do you have a Fingerprint Card?*

YesNo
Do you have a bachelor's degree?*

YesNo
Bachelor's Degree:
Do you have a master's degree?*

YesNo
Master's Degree
Do you have a High School Diploma or GED?*

YesNo
*Please note - We will need a copy of all Official or unofficial transcripts for both your Bachelors' and Masters' degrees.
Have you worked for any other Special needs agency before?*

YesNo
When and where?*
How many years of experience do you have with individuals with disabilities?*
Explain your experience with special needs/disabilities/elderly:*
Previous Employment

(please list only employment related to Tutoring/Teaching).
Previous Employment 1:
Company Name     Company Address and Phone #
Start Date   End Date
Job Duties
Previous Employment 2:
Company Name     Company Address and Phone #
Start Date   End Date
Job Duties
Previous Employment 3:
Company Name     Company Address and Phone #
Start Date   End Date
Job Duties
Education
Disabilities Awareness to include the following areas of impairment: deafness, blindness, physical, cognitive (learning disabilities), brain injury, development/cognitive, serious mental illness, etc.

YesNo
Barriers and issues that prevent individuals with disabilities (particularly severe disabilities) from entering andsucceeding in the workplace.

YesNo
Strategies necessary for achieving successful, long-term employment outcomes for individuals with disabilities and how these strategies will lead to improve.

YesNo
Work Readiness and Employability Skills.

YesNo
School 1:
School Name     School Address and Phone #
Start Date   End Date
Degree Awarded
School 2:
School Name     School Address and Phone #
Start Date   End Date
Degree Awarded
School 3:
School Name     School Address and Phone #
Start Date   End Date
Degree Awarded
It may take some time to get you a full, working schedule. Is this okay?*

YesNo
A typical schedule would include multiple shifts with different clients; those shifts can range from 2-3 hours long. Can you adapt to this type of scheduled?*

YesNo
There will be times where we need last minute coverage, would you be dependable for short notice coverage?

YesNo
If you are going to be absent or late, you must call the office and let the students, or students' family know. It is of high importance that you are punctual and reliable. Do you understand?*

YesNo
Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I authorize Elite Vocational & Tutoring Services LLC. to investigate information concerning my education, employment experiences and all other aspects of my background as may be necessary in arriving at an employment decision including contacting previous employers. I release Elite Vocational & Tutoring Services LLC. and its employees from all liability arising from such investigation.
Signature*
Date*

MonthDayYear
Date
Should be Empty:

Elite Vocational & Tutoring Services

APPLICATION FOR EMPLOYMENT

AVAILABILITY

Previous Employment

Education