TEAM MEMBER APPLICATION

APPLICANT INFORMATION
Name:
Date of birth: Phone: Secondary #:
Current address:
City: State: ZIP Code:
Licensed Driver? Y / N Own a vehicle? Type of Vehicle:
EMERGENCY CONTACT
Parent/Guardian Name:
Relationship: Phone Number: Home Work Cell
Parent/Guardian Name
Relationship: Phone Number: Home Work Cell
REFERRALS
Name: Relationship: May Contact? Y /
N
Phone Number:
Name: Relationship: May Contact? Y /
N
Phone Number:
Name: Relationship: May Contact? Y /
N
Phone Number:
EDUCATION
School Attended: Class of:
Major: Rank #/Out of: GPA (Overall if in HS):
WHAT SUBJECTS ARE YOU ABLE TO INSTRUCT? WRITE HONORS IF IT APPLIES
Math: English: Science: History:
Pre-Algebra / Under Elementary Literature Earth Science World History
Algebra I English I Integrated Science Social Studies
Algebra II English II Biology AZ/US History
Adv. Algebra H English III Chemistry Geo/World Cultures
Geometry English IV Anatomy/Physiology US Gov./Econ/Politics
College Algebra / Math AP Comp/Literature Physics European History
Financial Algebra College Prep Environmental Science Psychology
Pre-Calculus Political Science Sociology
AP Calculus I Modern Science
AP Calculus II AIM Sciences
List any additional classes/subjects you can teach (including examples such as electives, instruments, etc.)


ADDITIONAL INFORMATION

I understand that this form is filled out to the best of my knowledge. I understand that any notification of
any progress or rejection will be sent to me. I understand that an interview to further this application will
include a verbal application and other questions I may be required to answer. My signature confirms my
understanding.


On a separate piece of paper, write or type an honest response to the following questions:
1) Talk about yourself; some ideas may include hobbies, careers, etc.
2) Discuss your work ethic and your view on education, in general.
3) Provide an explanation as to why you are interested in this opportunity.

Signature of applicant: Date:
Signature of parent/guardian: (only if 17 / younger) Date: