Fillable Merced College Tutor A pplication Student Success Program (Merced College)

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Merced College Tutor A pplication Student Success Program (Merced College)

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  • 10 check-boxes
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Country of origin: US
File type: PDF

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For Office Use Only
Interview Date:
______________
Hire Date:
______________
Merced College
Student Success Program
Tutor A
pplication
Semester You Wish to Begin Tutoring:
___________________________
Today’s Date
: ________________
Student
ID: _________________________
Returning Tutor? Yes No
Last Name:
______________________
First Name:
_____________________
Middle:
___________________
Address:
__________________________________________
City
: _____________________
Zip
: __________
Phone:
__________________________
Student Email: _______
__________
____________@campus.mccd.edu
Can you provide verification of your legal right to work in the United States? Yes No
Are you currently working at Merced College in any capacity? Yes No
If yes, list job title & location: __________________
________________
__ How many hours per week? ______
Number of units enrolled in this semester:
___________ Major in School: ______________________________
What semester do you plan to graduate/transfer from Merced College?
_________________________________
List language(s) you speak other than Engl
ish: _____________________________________________________
A
re
you willing to tutor in this language(s)? Yes No
COURSES TO BE TUTORED-In order of preference, list the course(s) you wish to tutor
and the grade you
received for each course.
Course Name
Grade
Semester & Year
Instructor
College Name
AVAILABILITY-Please provide your schedule for the week in the area below.
Use (X) for hours you are available for tutoring.
Use (C) for hours you are in class.
*Be sure to allow yourself enough time to walk to/from the lab you will be working in and your classes.
Monday
Wednesday
Friday
8:00 – 9:00 AM
9:00 – 10:00 AM
10:00 – 11:00 AM
11:00 AM – 12:00 PM
12:00 –1:00 PM
1:00 – 2:00 PM
2:00 – 3:00 PM
3:00 – 4:00 PM
4:00 – 5:00 PM
5:00 – 6:00 PM
6:00 – 7:00 PM
2
Updated: 5/7/2020
WORK HISTORY-Please provide your work history in the area below.
Company
Name
Job Title
Name of
Supervisor
Phone
Number
Reason for
Leaving
May we
contact for
reference?
Writing Sample
Please explain why you would like to be a tutor. What experience and education do you have that qualifies you
to be a tutor?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_________________________________________________________________________________________
What experience do you have working with students of diverse ethnic and academic backgrounds?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_________________________________________________________________________________________
Disclosures and Signature
Have you ever been convicted of any crime(s)? Yes No
If you marked “yes”, please state each conviction, the specific charge for which you were convicted, the date, and place of conviction,
as well as the jail/prison sentence or fine you received. Please be aware that certain offenses need not be
repo
rted, including judicially
dismissed misdemeanors or expunged records, Penal Code 1203.4. A record of conviction will not necessarily constitute an automatic
bar to employment.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that
false or misleading information in my application or interview may result in my release.
Signat
ure:
Tod
ay’
s
Date
:
___________________
Please submit your completed Tutor Application via email to
tutoring@mccd.edu
Should you have any issues, please call us at 209-384-6329.
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Merced College Tutor A pplication Student Success Program (Merced College)

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Completed 5 September 2020

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