Virginia Tech Community Literacy Corps

Federal Work-Study Employment Tutor Application

Personal Information:

Name Student ID # First MI Last

Local Address Phone #

Email

Major Field of Study Expected Graduation Date

Indicate which semesters you are able to work during 2008 - 2009. r Fall r Spring

Your academic class: r Fresh. r Soph. r Junior r Senior r Graduate

Experience:

-Beginning with the most recent, please list your past employment experience. You can also include any relevant volunteer experience and training. You may also attach a resume.

Employer: Duties: ______

Supervisor: ______

Address: ______

______

Phone #: ______

Position/Date: ______

Employer: Duties: ______

Supervisor: ______

Address: ______

______

Phone #: ______

Position/Date: ______

-Have you been awarded Federal Work-Study for this school year? r Yes r No

-Do you have access to a motor vehicle? r Yes r No

-Are you willing to travel to sites outside of Blacksburg? r Yes r No

-Have you ever been convicted of a felony? r Yes r No

-If yes, please list case number and provide details: ______

______

-Please explain why you would like to work for the Literacy Corps.

______

-Describe any experience you have that would help you as a tutor for elementary school children:

______

-Please provide the names, addresses, and telephone numbers of two professional references. You may also attach references.

Name: Phone #:

Address:

Name: Phone #:

Address:

______

-Please list when you may be available for work/ meetings throughout the week this coming semester:

Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday

-I certify that the above information is true to the best of my knowledge. I understand that any intentional misrepresentation of information will disqualify my application from employment consideration as a Tutor for the VT Literacy Corps Program.

Signature Date