Right start tutors_application_desk[final]
- 1. RIGHT START TUTORS (RST) PO BOX 13345 BIRMINGHAM B11 9BR Mobile:07825040273 EDUCATIONAL SERVICES Fax:0871 253 4455 email:fs12@fsmail.net __________________________________________________________________________________________ APPLICATION FORM Surname:_________________________________________________________ Title:__________________ Forenames:_________________________________________________Previous names:___________________ Address:____________________________________________________________________________________ _______________________________________ Postcode:______________ Tel No:______________________ Mobile No:______________________________ E-Mail:____________________________________________ Maritial Status:_____________________ Ages of children:__________________________________________ Nationality:_________________________Date of Birth:__________________Age last birthday:___________ How long have you lived a) in the UK?:_______________b)at your present address?___________________ Subject/levels you can offer. List in order of preference: Subject (s) Level (s) ________________________________________________ __________________________________________ ________________________________________________ __________________________________________ ________________________________________________ __________________________________________ Are you prepared to tutor How far are you prepared to travel?______________miles a) In your own home? Yes/No Days available: Mon Tues Wed Thurs Fri Sat Sun (circle) ____ ____ ____ ____ ____ ____ ____ Times available:____ ____ ____ ____ ____ ____ ____ b) In the pupils home? Yes/No (write under ____ ____ ____ ____ ____ ____ ____ days) ____ ____ ____ ____ ____ ____ ____ Please state your academic qualifications:_________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ University,Polytechnic,College attended:_________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ If you are teaching at present give details: Name and address of establishment:_____________________________________________________________ __________________________________________________________Your position______________________ This information will be kept in strictest confidence and we will only contact the establishment with your permission.
- 2. Explain your present circumstances and list your experiences in teaching, tutoring and other employment: ____________________________________________________________________________________________ ____________________________________________________________________________________________ REFERENCES Please give the name of two referees (one of whom should be your current or more recent employer) Name:_______________________________________ Name:_________________________________________ Address:_____________________________________ Address:_______________________________________ ___________________________Postcode:_________ __________________________Postcode:____________ Phone:______________________Fax:_____________ Phone:______________________Fax:______________ Email:_________________ Email:____________________ Relationship to you:____________________________ Relationship to you:_____________________________ CV enclosed Yes/No Dfee/DES/DfES Reg No :( if applicable) ____________ Is there anything in your past history which would disqualify you from being placed in a position of trust with children and young adults? Yes/No Have you ever been convicted of a criminal offence, been bound over, received a caution, judgement or investigation pending against you, including spent convictions? Yes/No If yes supply details on a separate sheet which will be treated in confidence (complies with the rehabilitation of offenders act 1974.) __________________________________________________________________________________________________________________________________________ DECLARATION a) I understand a relevant Criminal Records Bureau Enhanced is needed. (you will receive more advice on this) b) I am in agreement with the aims of RST and with its statement of Principles and Code of Professional Conduct. My conduct, whilst tutoring for RST will reflect this trust. I will be concerned for my pupils and endeavour to give them good service. c) I understand that RST will not be held responsible for any injury, loss, accidental damage, personal indictment or any other claim whatsoever arising in connection with tutoring assignments. d) I promise to forward my commission on the sixth of each month in accordance with the guidelines provided on the scale of charges. I understand clients are informed that their commission included in the total fee will be paid to RST by the tutor. e) I understand that I am legally required to hand on all collected commission and will be charged interest and agency costs in recovering any due amount. (see terms and conditions) f) I understand commission is payable on all direct, indirect and declared clients registered with RST and commission is due on all those clients whether they are taught continuously or after a break of any length. g) I enclose required documents as specified in the enclosed ‘Documents to be forwarded’ letter. h) I have completed this application form honestly. i) I agree with the Terms and Conditions enclosed. Signed:________________________________________________ Date:_____________________ _________________________________________________________________________________________ For office use:_____________________________________________________________________________