TUTOR REGISTRATION FORM Insert your

recent photo
GROOVY EXCELLENT EDUCATION (GEE)
here(please
resize it first)

Full Name : Citra Baskoro,

SST_____________________________________________

Religion : Islam_________________________________________________________

Gender : Male / Female *)

Place, Date of Birth : Jakarta, 28 November 1989_________________________________

Current Address : Jl. Melati VII BS.41 No.30 Komplek Perumahan

Kranggan Permai RT.007 RW.011 Kel.Jatisampurna

Kec.Jatisampurna, Kota Bekasi-Jawa Barat

Phone/Mobile number : 085287931715_________________(whatsapp available: YES/NO*)

BBM & Skype (optional) : __________________________________________________________________

E - Mail : citra281189@gmail.com___________________________________

Bank Account Number : 776008767__________________(BCA/Mandiri/BNI/Other)

Branch: Syariah Lhokseumawe

City : Lhokseumawe

Able to teach : Full in English/Bilingual (mix) /only in Bahasa Indonesia*

Educational History : Senior High School : SMUN 99 Jakarta_______________________

University/ College : Sekolah Tinggi Ilmu Statistik (STIS)__

Department/ Major : Statistical Economics_________ _

Latest GPA : 3,14_____________________________________

Achievement (s) : 1. Awardee Scolarship APBN BPS Magister Ilmu

(Scholarship, research
grant, participant / winner Ekonomi Universiy Of Indonesia
of a competition, student
The mediocre teacher tells. The good teacher explains.
exchange,
The superior teacheretc)
demonstrates. The great teacher inspires. 1
-William Arthur Ward-
TUTOR REGISTRATION FORM
GROOVY EXCELLENT EDUCATION (GEE)

2._________________________________________________________________

3._________________________________________________________________

Language proficiencies :

Language Language proficiencies (Basic / Intermediate / Advanced *))

Reading Writing Listening Speaking

English

Intermediate Intermediate Intermediate Intermediate Intermediate

*) Please delete the example when you fill the form (also delete this note when you send to us)

Teaching Experience *) :

Level and Grade Curriculum Status Period

Senior High Scool, Mathematics, SMA N 81 Tutor Okt 2013-
Second Grade Jakarta Private Sept2014
Senior High Scool, Mathematics, Phisycs, Tutor Okt 2013-
First Grade Chemistry SMA Private Sept2014
Labschool Jakarta
Elementary School, All Subjects, Tiara Tutor Okt 2013-
4Th Grade Bangsa International Private Sept2014
School
Junior High School, Mathematics, Phisycs, Tutor Okt 2018-
3rd Grade Chemistry, SMP Al Azhar Private January2019
Cibubur
*) Please delete the example when you fill the form (also delete this note)

Additional Note : ___________________________________________________________________

(Any information that you

___________________________________________________________________
think GEE, student (s) and
parent (s) need to know)
___________________________________________________________________

The mediocre teacher tells. The good teacher explains.

The superior teacher demonstrates. The great teacher inspires. 2
-William Arthur Ward-
TUTOR REGISTRATION FORM
GROOVY EXCELLENT EDUCATION (GEE)
Student Category
(Put check-list on the empty
box provided based on the
students level that you are
able to teach)
Subject(s)
(Subjects mastered)
Teaching Schedule
(Put check-list on the empty box
provided based on your day
availability in teaching and the
detail of teaching hours. Ex: At 4
pm – 7 p.m)
Transportation
Students Location Preferences
Minimum Expected Fee
Status
Where do you know about us ? : Friends/Facebook/ Website/other
The mediocre teacher tells. The good teacher explains.
The superior teacher demonstrates. The great teacher inspires.
-William Arthur Ward-
___________________________________________________________________
: Elementary Junior High School
Senior/ Vocational University / General
High School
: Matematics All Grade, Statistics, English All Grade,
Science Junior High School or Below
__________________________________________________________________
: Monday At : __________________________________
Tuesday At : __________________________________
Wednesday At : __________________________________
Thursday At : __________________________________
Friday At : __________________________________
Saturday At : __________________________________
Sunday At : __________________________________
: Motorcycle/Car/Public Trans./ Other_______________*(write)
: Cibubur and Depok
: IDR 150.000 /meeting.
: Part time tutor / Full time tutor *)
(*write)
3
TUTOR REGISTRATION FORM
GROOVY EXCELLENT EDUCATION (GEE)

REGISTRATION DISCLOSURE STATEMENT

I hereby certify that statement and information in this registration form are true and
correct to the best of my knowledge and belief, and I authorize the Groovy Excellent
Education to investigate all statements or other information contained in this
registration form and any attachment submitted with it, unless I have stated wrong in
contrary.

I understand and agree that:

1. Any misinterpretation, falsification or material omission of any information
on this registration form may result in my failure to receive an offer, or, if I
am hired, in my dismissal from my employment
2. All offers of employment are conditioned on the provision of satisfactory
proof of an applicant’s identity and legal authority to work in Groovy
Excellent Education
3. An investigation may be made during the processing of this registration form,
and I authorize any of the persons or entities referred to in this registration
form to provide any and all information concerning my previous employment
(s) or the other statements I have made in connection with this application

Bekasi, 09 Agustus 2019

Citra Baskoro, S.ST

The mediocre teacher tells. The good teacher explains.

The superior teacher demonstrates. The great teacher inspires. 4
-William Arthur Ward-