2024-2025 Sixth Avenue CDC Tutor Application
Full Name
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First Name
Last Name
Mailing Address
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Street Address
Street Address Line 2
City
State
Zip Code
Phone Number
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Area Code
Phone Number
Email
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example@example.com
Date of Birth
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-
Month
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Day
Year
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Age
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Gender
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Male
Female
T Shirt Size
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Youth XS
Youth S
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult 2X
Adult 3X
Desired Position
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Tutor
Administrator
Driver
Select all grades with which you have experience working
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K - 1st
2nd - 3rd
4th - 5th
6th - 8th
9th - 12th
Tutor Interest Meeting will be held on Tuesday, November 12, 2024 at 5:00 pm.
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I acknowledge the meeting date and agree to attend.
I am unable to attend the meeting.
Sixth Avenue CDC Tutoring Program will offer 45 min sessions on Tuesdays and Thursdays to elementary and middle school students approximately 5:00 pm - 5:45 and high school students approximately 6:00 - 6:45. Please indicate your availability.
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Tuesday and Thursdays
Tuesdays only
Thursdays only
Sixth Avenue CDC Tutoring Program will offer 45 min sessions on Tuesdays and Thursdays to elementary and middle school students approximately 5:00pm - 5:45pm and high school students approximately 6:00pm - 6:45pm. Please indicate your availability.
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Tuesdays and Thursdays
Tuesdays only
Thursdays only
Education and Employment History
Upload Resume (optional)
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Provide Highest Level of Education (School, diploma/degree received, and dates attended)
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Experience and Skills
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No Experience
Assisted Only
1-3 Years Leading
3 or More Years Leading
Small Group Management
Group Activities
Reading
Math
Science
Administration
Transportation
Teaching or Tutoring Experience
Please answer the following if you have camp or classroom experience.
Provide the following: 1. Name of School/Program 2. Dates worked 3. Position held
Professional References
Only list professional references (no relatives) who can attest to your work ethic and character.
Provide 2 references (name, relationship to you, and phone number)
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EMERGENCY CONTACT INFO
In the event of an emergency, please provide a contact person.
Emergency Contact Name
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First Name
Last Name
Relationship to Applicant
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Emergency Contact Phone Number
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-
Area Code
Phone Number
Background Check Authorization
I authorize investigation of all statements herein, including any checks of criminal records, and release the CDC and all others from liability in connection with same. I understand that misrepresentations or falsifications herein or submitted by me, the applicant, will result in dismissal upon discovery.
Are you currently, or have you ever been, listed on a sex offender registry?
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Yes
No
Are you currently, or have you ever been, listed on a child or adult dependent abuse registry?
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Yes
No
Have you ever been terminated or asked to resign from a position?
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Yes
No
Printed Name of Applicant
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Signature of Applicant
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Submit
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