Encore AfterSchool Application
First Name
Last Name
Date of Birth	(mm/dd/yy)
Street Address
Apt #
City
State
Zip Code
Phone	(xxx) xxx-xxxx
Email
How did you hear about Encore After School (please be specific)?
Availability
Amount of time you are interested in working 20 or more hours/week 10-20 hours/week Less than 10 hours/week

In which region do you seek employment?

Oakland
San Jose

What days and times are you available?   

Monday	Tuesday	Wednesday	Thursday	Friday

Please check the position for which you are interested in applying (check all that apply)
Site Coordinator
Academic Instructor
Enrichment Instructor

What grade levels are you interested in instructing? (check all that apply)
Elementary
Middle School
Whatever Needed

What subjects are you interested in tutoring/instructing? Please list all that apply (e.g. math, reading, art, dance, music, environmental education)


When can you start?


Experience

Highest level of education completed
Primary language spoken
Additional languages

List or describe your past work experience


List or describe any previous work or volunteer experience with youth (i.e. clubs, churches, service groups).


Do you have any special skills, talents, or interests?


Why do you want to work as an Encore after school instructor?


Background Check
All instructors serving in public schools are required to complete a health screening (TB Test), criminal background check (fingerprint clearance), and reference check to ensure the safety and well-being of our children.

Please list two references.

	Name	Daytime Phone # or email	Relationship
1
2

Have you ever been convicted of a crime?

Yes
No

If “Yes,” please describe the circumstances of the conviction. If the criminal background check reveals any conviction(s) that you did not disclose in this application, your failure to disclose the convictions will result in termination from the program.


I certify that the information provided in this application is true and correct to the best of my knowledge. I understand that during the course of my association with Encore After School my personal information may be shared with program partners for volunteer placement purposes.

I authorize Encore After School to disclose this information with program partners.