Name                     

Date:                      

Previous Names:      

Address:

Postcode:                

Tel. No;                   

Mobile No;                

Email:                      

Date of Birth:            

Age last birthday:      

Marital Status:            Married Single Divorced Widowed

How long have you lived: 

A) In the UK?              

B) At present Address?

Nationality:            British European Community Non-European Community

If Non European Community:

Nationality:

Do you have a work permit? n/a Yes No

(You will be required to provide your original work permit by post before being accepted by Elite Home tutors).

Subjects/level you can offer, (in order of preference)...include subject followed by level

Any further details your interests or experience relevant to the above:

Are you prepared to tutor in:

A) your own home:  Yes No

b) the pupil's home: Yes No

How far are you willing to travel?

Approx. hours available per week?:

Are you available at weekends?:

Saturday: Yes No

Sunday:  Yes No

Please state your academic qualifications:

University, college, polytechnic attended:

Are you currently teaching in an educational establishment?

Yes No

Name and address of establishment:

Your position:

If you are not teaching at present, please list your experience in teaching, tutoring and other employment:

If you are not working at present, please describe your current circumstances:

Professional reference:

Name:     

Position:  

Address:

Character reference:

Name:    

Position: 

Address:

Are you able to supply a CV?:

Yes No (we will e-mail you for details)

Is there anything in your past history which would disqualify you from being placed in a position of trust with children or young adults?:

Yes No

Have you ever been convicted of a criminal offence, been bound over, received a caution, judgement or investigation pending against you, including spent convictions?:

Yes No

(If yes - we will contact you for details, which will be treated in confidence)

a) Please note that we are an agency, we do not employ tutors. 

b) Fees should be paid at each lesson or in advance, but never in arrears. It is normally the responsibility of the tutor to discuss with the client the arrangements for payment, and then to collect the inclusive fee from the client. 

c) Please note that under the Criminal and Court Services Act 2000 it is an offence; for an individual who has been disqualified from working with children to knowingly apply for, offer to do, or accept or do any work in a regulated position. An individual is disqualified from working with children if he / she is included on certain lists held by the Criminal Records Bureau, or has been disqualified from working with children as part of a sentence.

 DECLARATION

a) I have completed this form honestly to the best of my knowledge. 

b) I promise to forward all commission cheques to Elite Home Tutors ( made payable to Elite Home Tutors) within six days of the end of each calendar month. 

c) I understand that Elite Home Tutors will not be held responsible for any injury, loss, accidental damage, personal indictment or any other claim whatsoever arising in connection with tutoring assignments. 

d) I understand that all referrals must be passed on to Elite Home Tutors and that no details of past, present or future clients are given to any other party.

I have read the above declaration and agree to be bound by its terms: I have read and agree to be bound by the above I have not read the declaration  

Date:

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