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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3
Updated: 1/18/2018
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: _________________________
Gender
: ________________
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
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
Tuesday
Wednesday
Thursday
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
4
Updated: 1/18/2018
WORK HISTORY-Please provide your work history in the area below.
Company
Name
Job Title
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
:
___________________
5
Updated: 1/18/2018
Merced College
Student Success Program
Faculty Recommendation Form
Applicant’s Name: Student ID: _______________________
I recommend this student to tutor for the following course(s) and the levels below: _______________________
Evaluation of Student
(5)
Exceptional
(4) Exceeded
Requirements
(3) Met
Requirements
(2)
Marginal
(1)
Unsatisfactory
Demonstrated knowledge of subject
Academic maturity
Verbal communication skills
Responded effectively to assignments
Class attendance
Potential to teach
Interaction with other students
Additional Comments
I highly recommend this student for the tutor p
osition
.
I recommend this student for the tutor position with
reserv
at
ions
.
I do not recommend this student for the tutor p
osition
.
Additional comments:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Faculty Signature: Date: ________________
Faculty Print Name: _________________________________________________________________________
Position/Title: ______________________________________________________________________________
Phone: E-mail: _____________________________________________
Please submit this form to the Student Success Office at Stop #28 or to the Tutorial Center at Stop #21.
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Merced College Tutor A pplication Student Success Program (Merced College)

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Completed 14 December 2021

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