Empowering Independence for All Abilities | UVdN

Get in Touch

Address: 736 Southeast Jackson Street, Roseburg, Oregon 97470, United States

Phone: 541-672-6336

Fax: 541-672-8606

Online Tutor Application

First Name:

Last Name:

Home Address:

City:

Zip Code:

Home phone number:

Email address:

Date available to start:

Preferred shift times for tutoring between 8am-4pm?

Preferred days for tutoring from Monday – Thursday?

Are you 18 years of age or older?

Under 18

Over 18

Do you have access to a reliable ride?

Yes

No

Describe any past tutoring or teaching experience.

Describe any relative special skills, interests, strengths.

List any languages you speak other than English.

Free Text

Current Employer’s Name:

Supervisor’s Name and Phone Number:

What was your title?

What type of work did you do?

What dates did you work there?

Why did you leave?

Free Text

Previous Employer’s Name:

Supervisor’s Name and Phone Number:

What was your title?

What type of work did you do?

What dates did you work there?

Why did you leave?

Free Text

Emergency Contact Name and Phone Number:

Do you agree to fingerprinting and a background check?

Yes

Address

736 SE Jackson Street
Roseburg, OR 97470

Phone

Fax

Hours

Monday-Thursday: 8AM-4PM
Friday - Sunday: CLOSED

Closed for Lunch:
Monday-Thursday 12PM-1PM
Closed all major Holidays

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