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Name
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Address
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SS Number
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Date of Birth
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Phone Number
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Cell Number
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Emergency Contact Number
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Email
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Highest Level of Education
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Do you have a criminal or protective service history?
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Yes
No
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What position are you applying for:
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If yes, please explain:
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Do you have a Nation wide Finger Printed Police Clearance? If not, upon being contracted, you must obtain an official clearance.. (please
note: clearance cannot expire before tutoring sessions end).
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Yes
No
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Do you have any health concerns or limitations that we should be aware of?
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Yes
No
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If yes, please explain:
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How will you get to work? Do you have an alternative plan?
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Please list special talents or other interest:
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**PAYSCALE AND HOURS MAY DECREASE BASED ON STUDENT ATTENDANCE**
I understand, as stated by the Michigan Unemployment Insurance Agency, that this is a contractual agreement between myself and the Higher
Ground Program, if I am contracted by the Higher Ground Program as a “Contractor/Tutor" I will be ineligible to collect unemployment, and is responsible for my own workers compensation plan. I futher understand that this contract, nor my position as a "Contractor/Tutor", with the Higher Ground Program is not based upon my ability to keep the number of allotted students. |
Agree
Dissagree
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Today's Date
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Image Verification
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