Reach One Teach One

Name:

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Date of birth e.g.(01/01/2001):

Race:

Day phone:

Evening phone:

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E-Mail address:

Position applying for:

Emergency Contacts

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Phone:

Name:

Phone:

Personal History

Are there any health issues that will prevent you from performing your work responsibilities at a high level of performance?

If yes, please explain:

Reference

Name:

Relationship:

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Length of relationship:

Have you ever been convicted of a felony? If yes, please explain:

*A criminal background check is a major city and county requirement for working with children.

By checking this box, I certify that the information contained in this application is accurate to the best of my knowledge. If any information contained in this form is found to be inaccurate, I am subject to any and all pertinant legal action.

Reach One Teach One, Inc. is a 501(c)(3) non-profit organization created to provide educational and social enrichment programs for pre-adolescent and adolescent youth between grades K-12 in urban primary and secondary schools. This organization will also provide services to the participating parents, with efforts to enhance and promote family. The programing values of Reach One Teach One Inc. are focused on the following four areas (click an item to learn more):