EMPLOYMENT APPLICATION FORM MONITORS & TUTORS

Save & Return

Use an account to return to saved work.

PERSONAL INFORMATION

Last Name *

First Name *

Street Address *

City *

State *

Zip Code *

Email Address *

CellPhone Number *

Alternative Phone Number *

PURPOSE

Why do you want to work at Sipnayan Math Center? *

0/300 words

Why do you think Sipnayan Math Center should hire you? *

0/300 words

What are your expectations in terms of your job responsibilities, as a tutor or monitor? *

0/300 words

EDUCATION

High School *

Year Graduated *

City *

State *

If you are in high school or did not complete high school, please explain the details of your academic status, i.e. grade level completed, GPA, reason for not completing high school.

Post-Secondary (Start from the most recent.)

	School	Degree	Major	Year
1)	School	Degree	Major	Year
2)	School	Degree	Major	Year
3)	School	Degree	Major	Year

Most Recent Transcript of School Records *

AVAILABILITY

Please list the times that you are available on each day given

	TIME AVAILABLE
Mondays	TIME AVAILABLE
Tuesdays	TIME AVAILABLE
Wednesdays	TIME AVAILABLE
Thursdays	TIME AVAILABLE
Fridays	TIME AVAILABLE
Saturdays	TIME AVAILABLE

WORK AUTHORIZATION

Only US citizens and aliens with legal documents to work in the United States are eligible for employment. If you are not a US citizen, Sipnayan Math Center and Afterschool program will require a copy of your Employment Authorization Document (EAD), Permanent Resident Card (green card), or any other visa that authorizes you to work with ANY US employer.

I certify that I am legally authorized to work in the United States under the authorization chosen below. *

If you chose "other", please write the type of visa that you have.

If you are not a US citizen, please upload a copy of your EAD or greencard.

BACKGROUND CHECK

IMPORTANT! It is a 21st CCLC program requirement that all employees, service contractors and volunteers who work with the program have approved criminal background check. The center will run the following background check before hiring:

NC Sex Offender Database and National Sex Offender Database
Statewide Criminal Background Check including all states in which the employee or volunteer lives or has lived for the previous five (5) years.

Please note that individuals convicted of any kind of felony and/or any offense involving sexual or physical abuse/neglect against a child are strictly prohibited from working with the 21st CCLC Program.

Please type your initial across each statement.

	Initial
1) I authorize Sipnayan Math Center and Afterschool Program LLC to conduct an investigation of my background using the NC Sex Offender Database and the National Sex Offender Database.	Initial
2) I authorize Sipnayan Math Center and Afterschool Program LLC to conduct a national criminal background check to include all states in which I live or have lived in the past 5 years.	Initial
3) I understand that if I was found convicted of any kind of felony and/or any offense involving sexual or physical abuse/neglect against a child, I will not be eligible to work with the 21st CCLC Program run by Sipnayan Math Center and Afterschool Program LLC.	Initial
4) I understand that my social security number is necessary to run an accurate criminal background check. For the security of my personal information, I understand that this information will not be collected online. Therefore, I agree to provide my Social Security number via phone to Sipnayan's HR representative.	Initial

First Name *

Last Name *

MI *

List all other names that were used previously. Please use one box for each former name.

+-

DL State *

DL Number *

Expiration Date * +

Date of Birth * +

List ALL addresses in the last 5 years starting on the current address.

	Street	City	State	From-To (Year)
1)	Street	City	State	From-To (Year)
2)	Street	City	State	From-To (Year)
3)	Street	City	State	From-To (Year)

Applicant Signature *

clear

Thank you for completing the application. We will let you know of the next steps in the process once your application is reviewed. Thanks!