Required fields are underlined.

Full Name: Telephone:
Address:
Street/P.O. Box: City:
State: ZIP Code:

Birth Date: E-mail:
Current Occupation:

Employment & Volunteer Experience:

	Organization	Supervisor/Phone	Position	Start Date	End Date
1
2
3

May we contact your previous supervisors (if necessary)?
Yes
No

Why do you want to be a tutor with the McKinney Tutoring Program?

Please describe any knowledge, skills, or experience you have related to tutoring or working with children.

Tutoring sessions are once to twice a week for approximately 45 minutes to 1 hour each session. Which day(s) and times are you available to tutor?

Are there any qualifications listed in the job description which you feel you may not meet? Please explain.

Do you have any health issues or other restrictions that would need accommodation if you are selected as a tutor?
Yes
No

Please list two references who can speak to your qualifications for this position. List names and telephone numbers.

	Name	Telephone
1
2

Have you ever been convicted of child physical or sexual abuse?
Yes
No

If yes, please explain.

Have you ever been convicted of a crime against a person (assault, homicide, sexual assault, partner/family member assault)?
Yes
No

If yes, please explain.

How did you hear about the McKinney Tutoring Program?

Applicant's Statement: The information presented in this application is true to the best of my knowledge.

Thank you for your interest in the McKinney Tutoring Program. If you have any questions, please call Amber Jackson at 543-3550 x 27. Amber will be in contact with you to schedule a phone or in-person interview.