Privacy Statement: The personal information on this form is being collected for the purposes of recruiting and selecting Independent Contractors wishing to provide services for Back to the Basics Tutoring LLC. Information may be used to complete a background check to ensure the safety of the children. Social Security Number (for background check only)
Do you have a driver's license?
If yes, please provide your License # If no, please provide your State ID # Please provide us with a copy of your Social Security Card and State-Issued License. Highest Level of Education List any classes, courses, certifications, and/or professional development training you have completed that has prepared you to reach diverse populations of children? Institution/Facility Hosting the Course Objective/Purpose of the Course Institution/Facility Hosting the Course Objective/Purpose of the Course Institution/Facility Hosting the Course Objective/Purpose of the Course Current Employer, if applicable: Duties/Responsibilities Duties/Responsibilities Duties/Responsibilities Accomplishments/Honors/Awards Educational Software & Technology Skills (ex: Zoom, Google Classroom Mobymax) Groups, Clubs, Organizational Memberships Please describe your prior experience related to tutoring (include Organization Names and dates of service) What experiences have you had that may prepare you to offer work as a contractor in the field of tutoring, reading help, at-risk youth, mathematics, etc.? Why do you want to provide services to Back to the Basics Tutoring? (Or, What do you want to gain from providing these services?) Have you ever been convicted of a crime?(If yes, please exmplain the nature of the crime and the date of the convicction and disposition.) Conviction of a crime is not an automatic disqualification for contracted work, but may lead us to not hire you. Please list three people who know you well and can attest to your character, skills, and dependability. Include your current or last employer.
Please read the following carefully before signing this application: I understand that this is an application to determine suitability to hire my services as a tutor on an independent contracting basis and any information contained on my application will be used to conduct background verifications by Back to the Basics Tutoring. I authorize Back to the Basics Tutoring LLC to make any inquiry of or receive information from any person or organization regarding my or my entity’s suitability. I do hereby give permission to these persons or organizations to provide such information. These inquiries may include and are not limited to the quality and quantity of my work, employment history, qualifications, and any criminal records. In regards to the release of such information, I hereby waive, release, and agree not to sue or proceed with legal actions against any person or organization including but not limited to Kiyana Mensah, Back to the Basics Tutoring LLC, their agents, affiliates, partners, sponsors, associates, members and employees for the result of providing, obtaining, or acting upon such information. I also give this waiver, release, and agreement not to sue for myself, my heirs, assigns, and successors. I certify that I have and will provide information throughout the selection process, including on this application and in interviews with Back to the Basics Tutoring LLC that is true, correct, and complete to the best of my knowledge. I certify that I have and will answer all questions accurately to the best of my ability and that I have not and will not withhold any information that would affect my suitability. I understand that misrepresentations or omissions may be cause for immediate rejection or termination of any contracted services with Back to the Basics Tutoring LLC. Back to the Basics Tutoring LLC is committed to the safety and well-being of all children and young people accessing our service. We support the rights of the child and will act without hesitation to ensure a child-safe environment is maintained at all times. We also support the rights and well-being of our staff and contractors and encourage their active participation in building and maintaining a secure environment for all participants. Submit