Aloha Nannies Tutor Application

Tutor Application

Please complete the following form and click Submit. You will receive an email copy of this application. Please save this email and reference it if you need to make any changes in the future. Note: you can not save this form and continue it later, it must be completed and submitted at the same time. Allow yourself 15-30 minutes to complete.

A * next to each field label means that an entry in this field is required.
* First Name
* Last Name
* Address
* City
* State
* Zip
Country
Home Phone (include area code)
Work Phone (include area code)
Cell Phone (include area code)
* E-mail Address
Date of Birth

Childcare Employment History
Most Recent		Please indicate areas of expertise
Employer: Address: City: State: Zipcode: Phone Number: Childrens ages: Date Started: Date Left:		Teaching subject(s)	Tutoring subject(s)
Other job duties (be specific):

Second Most Recent		Please indicate areas of expertise
Employer: Address: City: State: Zipcode: Phone Number: Childrens ages: Date Started: Date Left:		Teaching subject(s)	Tutoring subject(s)
Other job duties (be specific):

3rd Most Recent		Please indicate areas of expertise
Employer: Address: City: State: Zipcode: Phone Number: Childrens ages: Date Started: Date Left:		Teaching subject(s)	Tutoring subject(s)
Other job duties (be specific):

Please Provide two Character references, i.e., work, school, religious, etc.:
Name: Phone: Relationship:		Name: Phone: Relationship:

Please provide Professional references relevant to assignments interested in:
Name: Phone: Relationship:		Name: Phone: Relationship:

Have you ever been convicted of a crime or violation of the law? Yes No		If yes, please explain:
Have you been registered with the DOE?Yes No		If yes, what state:
In Case of Emergency Notify: Name: Phone: Relationship: Street Address: City: State: Zip: Telephone Number(s):

Educational Background: 1. High School: Name of School & Location: Dates Attended: Graduation Date: Degree or Diploma: 2. College or University: Name of School & Location: Dates Attended: Graduation Date: Degree: 3. College or University: Name of School & Location: Dates Attended: Graduation Date: Degree:

List any additional course work, seminars, training or volunteer work: What teacher certificates do you hold? List any particular subjects and grade levels you have experience in tutoring. Do you have any experience with special needs children? Yes No If yes, please explain:

Are you legal to work in the U.S.? Yes No
CPR certified? Expiration Date Yes No
TB test? Expiration Date Yes No
Passport? Expiration Date Yes No

PERSONAL INFORMATION
Marital Status: Married Widowed Divorced Separated Single Partner
If you have children, list names, ages and whether they live with you 1. Name: Age: Live with you: 2. Name: Age: Live with you: 3. Name: Age: Live with you: 4. Name: Age: Live with you:
Who cares for your children while you are working?		Caregivers name, address and telephone number
Are you working now?Yes No		When can you start a new job?
During the next year, will any of the following activities conflict with your availability to work? (Check all that apply) Scheduled vacations/holidays Religious holidays/obligations Scheduled medical procedures Getting married Giving Birth School or evening classes Other No activities planned If "Other", please explain
What duties are you willing to perform in addition to tutoring? (check all that apply) Cook for children Travel Occasional Overnights Driving with children		What grade levels do you want to work with? (check all that apply) Pre-k K 1-3 4-6 Middle School High School College Prep College
How did you find out about Aloha Nannies Agency?		Have you registered with Aloha Nannies before: Yes No
Describe your driving record: 1. Speeding tickets (y/n): 2. Accidents/your fault (y/n): 3. Driving under the influence (y/n): 4. Other moving violations (y/n): 5. Accidents/not your fault (y/n): 6. Driver License suspended (y/n): If you answered yes to any of the above, please explain:
Current Drivers License No.	State of Issuance	Expiration Date:
Have you ever been issued a drivers license from another state or country? Yes No		If yes, please explain:
What type of work are you looking for? (check all that apply)		What days and hours are you available to work?
Long Term (1 year+) Live in or out Live In Live Out Part Time Full Time On-call Babysitting Weekend Temporary		Monday: From: To: Tuesday: From: To: Wednesday: From: To: Thursday: From: To: Friday: From: To: Saturday: From: To: Sunday: From: To:
Salary range desired (complete all that apply):		Do you speak or write any other languages?
Hourly: Minimum Maximum Weekly: Minimum Maximum Overnight: Minimum Maximum

Please tell about your theories on education:
What teaching tools and techniques do you use?
Please share a positive experience you have had with teaching or tutoring in the past?
Please write a little about yourself, your interests and your talents:
Please check one box: You may contact my present employer You may NOT contact my present employer.

Please read the following carefully before submitting:
You understand that Aloha Nannies is not an employment agency and applicant will be working as an independent contractor. In the event of misconduct or negligence by you, you will not hold Aloha Nannies responsible. Tutor understands that Aloha Nannies will make agreed upon efforts to make a referral, which will result in the tutor being offered a position with a family. Aloha Nannies makes no guarantees or promises that the tutor will be offered a position. Tutor understands that the decision to hire the tutor rest solely on the client. You understand you have the right to choose or reject any work opportunity offered to you by Aloha Nannies. INDEMNIFICATION: Tutor agrees to release, defend, indemnify and hold harmless Aloha Nannies & and its directors, officers and employees (hereinafter collectively referred to as "Aloha Nannies") from any and all claims, losses, expenses, fees (including attorney’s fees) costs and judgments that may arise from or relate to the services provided by Aloha Nannies to client and tutor. Aloha Nannies is referral service acting on your behalf and is not your employer; therefore, the responsibility of reporting general excise, federal and state taxes and any other required taxation is yours. You agree not to work for any client referred to you by Aloha Nannies for one year after the effective date of your disassociation with Aloha Nannies. It is understood that no interviews will be scheduled until this contract has been signed and received by Aloha Nannies. I hereby acknowledge receipt of a copy of this agreement. You agree that you have fully read and understood each statement in this agreement and acknowledge this by your signature below. Signature Date
Please type your full name:		Date:

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Tutor Application

Childcare Employment History

PERSONAL INFORMATION