Fillable City of Diamond Bar Community Services Department (City of Diamond Bar)

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City of Diamond Bar Community Services Department (City of Diamond Bar)

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The City of Diamond Bar Community Services Department (City of Diamond Bar) form is 2 pages long and contains:

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  • 0 check-boxes
  • 74 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Diamond Bar

BROWSE CITY OF DIAMOND BAR (CA) FORMS

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City of Diamond Bar Community Services Department
CONTRACT CLASS INSTRUCTOR APPLICATION
A Contract Class Instructor provides instruction, in the area of the
individual’s expertise, for tots, youth, teen, or adult classes.
Please type or print in ink.
Name:_______________________________________________________________________________________________
Phone Day:_____________________________________ Evening:____________________________________________
Cell: Fax:________________________________________________
Which number(s) may be given out to the public?___________________________________________________________
Address:_____________________________________________________________________________________________
City: Zip:____________________________________________
Social Security or Federal Tax ID Number: (Kept confidential)
Proposed Course(s):___________________________________________________________________________________
Related Educational Background and Institutions Attended:__________________________________________________
_____________________________________________________________________________________________________
Related Experience: (Attach resume if available)
Agency: From:
Title: To:
Agency: From:
Title: To:
Description of Duties:
Description of Duties:
Specialized Training:_________________________________________________________________________________
___________________________________________________________________________________________________
References: (Work or teaching related)
Name Title Phone
1.__________________________________________________________________________________________________
2.__________________________________________________________________________________________________
3.__________________________________________________________________________________________________
As an adult, have you ever been convicted (or are currently out on bail or out on your own recognizance pending trial) of a felony, or misde-
meanor other than a minor traffic violation? If so, list what, when, where, and disposition of case on the back of this application or on an
attached sheet. (Note: A criminal record does not constitute an automatic bar to acceptance as a contract class instructor, but will be con-
sidered in terms of the activities to be performed in the capacity of contract class instructor.) _______ (please initial)
As a condition of employment and in compliance with the State of California Education Code 10911.5 or Public Resources Code 5164, all
independent Contractors must be fingerprinted if they work with minors (children under 18 years old). This law has been put into effect to
protect and reduce risk to minors. _______ (please initial)
I certify that all statements on this application are true and complete to the best of my knowledge. I hereby authorize the City of Diamond
Bar to investigate any information contained in this application. I understand false or incomplete statements shall be sufficient cause for
disqualification or dismissal of contract. _______ (please initial)
Signature:_________________________________________Date:_________________
Agency: From:
Title: To:
Description of Duties:
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signature
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City of Diamond Bar Community Services Department
CONTRACT CLASS INSTRUCTOR APPLICATION
A Contract Class Instructor provides instruction, in the area of the
individual’s expertise, for tots, youth, teen, or adult classes.
Please type or print in ink.
Additional Instructor(s) and/or Assistant(s);
Name:_______________________________________________________________________________________________
Phone Day:_____________________________________ Evening:____________________________________________
Cell: Fax:________________________________________________
Which number(s) may be given out to the public?___________________________________________________________
Address:_____________________________________________________________________________________________
City: Zip:____________________________________________
Social Security or Federal Tax ID Number: (Kept confidential)
Instructing/Assisting Course(s):_________________________________________________________________________
Related Educational Background and Institutions Attended:__________________________________________________
_____________________________________________________________________________________________________
Agency: From:
Title: To:
Agency: From:
Title: To:
Description of Duties:
Description of Duties:
Specialized Training:_________________________________________________________________________________
___________________________________________________________________________________________________
References: (Work or teaching related)
Name Title Phone
1.__________________________________________________________________________________________________
2.__________________________________________________________________________________________________
3.__________________________________________________________________________________________________
As an adult, have you ever been convicted (or are currently out on bail or out on your own recognizance pending trial) of a felony, or misde-
meanor other than a minor traffic violation? If so, list what, when, where, and disposition of case on the back of this application or on an
attached sheet. (Note: A criminal record does not constitute an automatic bar to acceptance as a contract class instructor, but will be con-
sidered in terms of the activities to be performed in the capacity of contract class instructor.) _______ (please initial)
As a condition of employment and in compliance with the State of California Education Code 10911.5 or Public Resources Code 5164, all
independent Contractors must be fingerprinted if they work with minors (children under 18 years old). This law has been put into effect to
protect and reduce risk to minors. _______ (please initial)
I certify that all statements on this application are true and complete to the best of my knowledge. I hereby authorize the City of Diamond
Bar to investigate any information contained in this application. I understand false or incomplete statements shall be sufficient cause for
disqualification or dismissal of contract. _______ (please initial)
Signature:_________________________________________Date:_________________
Agency: From:
Title: To:
Description of Duties:
click to sign
signature
click to edit
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City of Diamond Bar Community Services Department (City of Diamond Bar)

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Completed 3 August 2020

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