Become a Tutor

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For Office Use Only

Applicant Form

First Name*

Middle/Maiden Name

Last Name*

Nickname

Date of Birth*

Information provided used for FDLE background screen

Social Security Number*

Information provided used for FDLE background screen

Home Phone

Cell Phone*

Other Phone

Specify other phone number

SAP#

Applying for position as*

Availible to start*

Teaching Information

When did you last hold a teaching position?

Florida's Teacher's Certification Number

Please upload a copy of your certificate here

Max. file size: 300 MB.

5-9 subject

6-12 subject

Other

Educational Data

Principal Field(s) of Specialization

Undergraduate major

Graduate Major

Employment Data

Give employment data as completely as possible, starting with present or most recent employer.

References

At least one reference must be an immediate supervisor.

Personal Data

Please explain*

How did you hear about this opportunity?*

1. If you already have fingerprints on file with Polk County Public Schools, the processing fee for your LRC Vendor badge will be a $10.00 money order made out to Polk County Public Schools. Keep a copy of your receipt, LRC will reimburse you ½ of your total ($5.00). There is no need to schedule an appointment for additional fingerprints. You will need to send a jpg of yourself with a blue background to: Pre-Employment Services, AllStaff@polk-fl.net along with the completed FSSR form.

2. All others will need to be screened. The charge for new fingerprints is $73.25 per badge. You will be reimbursed $36.63 from LRC but keep your receipts and turn them in to LRC for reimbursement. The $73.25 is due at the time you make your appointment with Fieldprint for fingerprints. You will need to pay online with a credit/debit card at that time. Once you have had your fingerprints done, you will complete the Notification of Fingerprint/Background Completion Form and send it to Pre-Employment Services, AllStaff@polk-fl.net. When Polk County Schools Fingerprint Department calls or emails you with a day and time to get your Vendor Badge picture, please take a $10.00 money order with you. Please keep your receipts as LRC will reimburse you ½ ($5.00) after you turn them in to us.

The answers to the foregoing questions are true and correct to the best of my knowledge. I hereby give authorization to the Learning Resource Center of Polk County, Inc. to contact my past and present employer(s) and references listed above.

By typing your name here you are agreeing to submit this form.*

Date*

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Thank you for applying! Upon receipt, a Program Manager will contact you to schedule an interview. Please note that tutors receive wage compensation based on certification, education, experience, and expertise. Thank you for your interest in working with LRC. We look forward to working with you!
-LRC Staff

Name

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Employment Application

For Office Use Only

Applicant Form

Teaching Information

Educational Data

Employment Data

References

Personal Data

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