Fillable ENGLISH LANGUAGE LEARNERS IN-HOME PROGRAM

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ENGLISH LANGUAGE LEARNERS IN-HOME PROGRAM

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ENGLISH LANGUAGE LEARNERS
IN-HOME PROGRAM
TUTOR APPLICATION
Return to Mailing Address: ELL In-Home Program
1894 E. William St. #4-125, Carson City, NV 89701 - or - Email to ana.torres@eslinhome.org
Prospective Volunteers will receive consideration without discrimination of sex, race, color, religion, sexual
orientation, gender identity or expression, age, disability or national origin or handicap. The English Language
Learners In-Home Program (ELL) is an Equal Opportunity organization. Information is used for statistical
purposes only, and contact information will not be shared with anyone outside the ELL organization.
Application Date: ____________________
Print Full Name: ____________________________________Date of Birth________________________ Age: __________
Home Address: _____________________________________City:_____________________State:______ Zip:___________
Country: _______________________Home Phone:______________________Cell Phone:___________________________
Email Address:_________________________________________ ☐Male ☐Female ☐ Other ☐ Prefer not to answer
Race/Ethnicity: ☐Hispanic/Latino ☐Asian ☐African ☐Caucasian ☐Native American ☐Other ____________
☐prefer not to answer
Tutor’s Availability Choose (at least) 2 days: ☐Mon. ☐Tue. ☐Wed. ☐Thurs. ☐Fri. ☐Sat. ☐Sun. Times: _______________
I will tutor in (check all that apply): ☐Student’s Home ☐My Home ☐School classroom ☐Public Site (i.e. library)
ONLINE: ☐SKYPE; ☐ZOOM; ☐Facetime, ☐WhatsApp ☐Google Meet ☐Other: _______________________________
I want to tutor (check all that apply): ☐ Beginner English ☐English Conversation ☐GED ☐Citizenship
Have you ever been terminated involuntarily from a paid or volunteer position or suspended from an educational institution?
☐ Yes ☐ No If yes, explain circumstances:
DO YOU SPEAK A FOREIGN LANGUAGE? (not required for tutoring)
If Yes, What language(s)? _________________________________ ☐ Fair ☐ Good ☐ Fluent
Do you want to learn a foreign language? ☐ Yes ☐ No If Yes, what language?_________________________
Level of Education: ☐Less than 12
th
grade ☐High School/HSE/GED ☐Some College ☐Undergrad Degree
☐Graduate Degree
EDUCATION: Name/Location Major/Degree Dates Attended (From- To)
High School: _______________________________________________________________________________________
College/University: __________________________________________________________________________________
Other: _____________________________________________________________________________________________
WORK HISTORY:
Current Employer: ____________________________ City/State:___________________ Phone:______________
Job Position and Duties:_______________________________________ Start Date________End Date________
Previous Employer: ____________________________City/State:__________________ Phone:______________
Job Position and Duties:________________________________________ Start Date_______ End Date________
HOW DID YOU FIND OUR PROGRAM? ☐Another Tutor ☐An ELL Student ☐A friend/relative ☐Online
☐Other: _______________________
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Are you willing to have a background check? ☐Yes ☐ No
Attending monthly Tutor Meetings is mandatory. ☐Yes ☐No
Are you willing to perform other duties (i.e., fundraising/training other tutors)? ☐Yes ☐ No
Business Reference: _________________________________________________ Phone_________________
Personal Reference: _________________________________________________ Phone_______________
Personal Reference: __________________________________________________Phone_______________
I certify that all statements contained in this application and any attachments are true and correct and that this
application is submitted with the knowledge that misrepresentation or failure to reveal information requested may
be deemed sufficient cause for denial of or dismissal as a volunteer tutor. I hereby authorize any and all persons
having information concerning me, either of public record or otherwise, to furnish it to the authorized agent of the
English Language Learners In-Home Program.
I hereby expressly waive, release and forever discharge the ELL In-Home Program and its agents, from any and
all manner of action and causes of action whatsoever (including auto accidents), which I, my administrators or
executors can, shall, or may have against the ELL In-Home Program, or its agents, as a result of my volunteering
with the ELL In-Home Program.
Print Name : ____________________________________________________ Date:_______________
Signature: ______________________________________________ ________
Liability Waiver
In consideration of my volunteer participation with ELL In-Home Program, I agree and understand that I
assume the risks inherent in my participation. And with full knowledge of the risks during the COVID-19
Pandemic, I agree to release and hold harmless ELL In-Home Program (ELL) and its staff and employees and
assigned representatives from and against any and all claims for personal injuries or damages of any kind arising
from my participation in any and all ELL programs and travel to and from any such programs, specifically tutoring
students face-to-face.
I hereby accept all risk and injury to health that may result from my participation and release ELL, its staff,
employees and assigned representatives from any and all liability to me or for all and any claims and causes of
action for loss of or damage to my property and for any and all illness or injury to my person, including death that
may result from or occur during my participation in any of ELL's programs at different sites of the approved
If I fail to keep my commitments (specifically tutoring and submitting monthly time sheets), I agree to return all
tutor books and other material given to me. If materials cannot be returned, I agree to reimburse the ELL In-
Home Program the cost for each book. I understand that this is a no-cost-to-student program, that my services
are on a volunteer and/or internship basis and that I will not receive remuneration from ELL In-Home
Program and assigned students.
are on a volunteer and/or internship basis and that I will receive no remuneration.
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programs at other locations, including transportation to or from such programs, whether caused by negligence of
ESL, its staff, employees or representatives, or otherwise.
I further agree to indemnify and hold harmless ELL, its staff, employees, and representatives from liability
for the injury or death of any person(s) and damage to property that may result from my negligence or intentional
act or omission while participating in, including transportation to or from, any ELL programs.
Understanding that ELL may be photographing and/or videotaping at any ELL program at which I
volunteer, I grant ELL permission to copyright and use my name and likeness including photographs, videos, etc. in
any and all of its publications, including website entries, without payment or any other consideration, in any manner
or form for any lawful purpose. I waive any right that I may have to inspect or approve the finished product or
written copy that may be used in conjunction therewith, or the use to which it may be applied.
Signature_________________________________Date___________________
OFFICE USE ONLY:
Name of Tutor Trainer: City/State: Date_____
Student(s)______ Start Date Book Level Days Time Location______
________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
TutorTrainer’sComments:_____________________________________________________________________________________________
_______________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_________________________________________________________________________________ (Rev.10/2021)
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ENGLISH LANGUAGE LEARNERS IN-HOME PROGRAM

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Completed 17 February 2022

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