Name                                                                                                                                 

Address                                                                                                                              

City                                                                                             ZIP                                  

Home phone                                        Cell Phone                           
E-mail                                 ______________________ 

Social Security Number                                                                     (Teachers/Subs only)

Employer                                                                                                       

Work Number                                                           

 Do you hold a Teaching Certificate?     YES              NO            

State                 Exp. date                  
  Endorsements                                                               

 Subjects (Please circle/list those you feel comfortable to tutor):

            Elementary:  PK   K  1  2  3  4  5    Subjects:                                                      

            Middle:           6  7  8   Subjects:                                                                          

            Math:  Algebra 1       Algebra 2       Geometry       Trigonometry      Math Analysis

                         Calculus        Prob. & Stat.                                                                       

            Science:  Biology         Chemistry   Physics          Earth Science                             

            Business:     Accounting        Statistics                                                                

            Languages & levels:                                                                                          

            Reading: methods/experience                                                                             

            Social Studies: Geography                                                                                 

            Study/organizational skills:                                                                               

            SAT/ACT Prep:       Math                  English                           
                  (Please list your scores)

Other Preps:            PRAXIS         GRE              GED               ASVAB         

Computers:  Operating Systems                                                _________  
                     Programming                                                                                    

            Special needs students (list):                                                                            

             Music Lessons:                                                                                                 

           
Preferred days and times:

            Mon.                  Tues.              Wed.               Thurs.                        Fri.

            Sat.                    Sun.

 Preferred Areas (please circle/list those cities/areas where you are willing to tutor):

        Virginia Beach                                                                                               
        Chesapeake:  Great Bridge  Hickory  Deep Creek  Western Branch                      
        Norfolk            Portsmouth                Suffolk            Isle of Wight
       Newport News           Hampton            Poquoson                  Williamsburg

Teaching Experience:
Name of school                  School System       Grade/subjects                   Dates

           
Education:
College/Univ.                                Dates                                     Major         Degree

 References (Please list three):

 Name                                     Position                    Address                                Phone

           
Personal Information:
Have you ever been discharged or refused contract renewal?   _                        

I hereby authorize Achievement Plus to conduct work history, personal reference, and police record inquiries to determine my acceptability for tutoring.  Further, I hereby authorize and direct any and all federal, state, or local agencies or offices that may possess information to cooperate and assist Achievement Plus in its investigation.
I certify that the information in this application is true and correct.

                                                                                                                                                                            Signature                                                                              Date