TUTOR REGISTRATION FORM Insert your

recent photo
WWW.GEETUTORING.COM here(please
resize it first)

Full Name : __________________________________________________________________

Religion : ___________________________________________________________________

Gender : Male / Female *)

Place, Date of Birth : __________________________________________________________________

Current Address : __________________________________________________________________

__________________________________________________________________

Phone/Mobile number : __________________________________(whatsapp available: YES/NO*)

BBM & Skype (optional) : __________________________________________________________________

E - Mail : __________________________________________________________________

Bank Account Number : _________________________________(BCA/Mandiri/BNI/Other)

Branch:

City :

Able to teach : Full in English/Bilingual (mix) /only in Bahasa Indonesia*

Educational History : Senior High School : ___________________________________________

University/ College : ___________________________________________

Department/ Major : ___________________________________________

Latest GPA :____________________________________________

Achievement (s) : 1._________________________________________________________________

(Scholarship, research
grant, participant / winner 2._________________________________________________________________
of a competition, student
exchange, etc) 3._________________________________________________________________

The mediocre teacher tells. The good teacher explains.

The superior teacher demonstrates. The great teacher inspires. 1
-William Arthur Ward-
TUTOR REGISTRATION FORM
WWW.GEETUTORING.COM

Language proficiencies :

Language Language proficiencies (Basic / Intermediate / Advanced *))

Reading Writing Listening Speaking

English

*) Please delete the example when you fill the form (also delete this note when you send to us)

Teaching Experience *) :

Level and Grade Curriculum Status Period

Example:1 Example: Private Example:
Elementary, Grade KTSP, Mathematics tutoring July 2010-October
(mention school name if
5th 2012
unsure about curriculum
and please inform)
Example:2 Example: Learning Example:
Senior High School, IGCSE, Mathematics Center or October 2010-
Grade 1st School Name present

*) Please delete the example when you fill the form (also delete this note)

Additional Note : ___________________________________________________________________

(Any information that you

___________________________________________________________________
think GEE, student (s) and
parent (s) need to know)
___________________________________________________________________

___________________________________________________________________

Student Category : Elementary Junior High School

(Put check-list on the empty

Senior/ Vocational University / General
box provided based on the
students level that you are
able to teach) High School
The mediocre teacher tells. The good teacher explains.
The superior teacher demonstrates. The great teacher inspires. 2
-William Arthur Ward-
TUTOR REGISTRATION FORM
WWW.GEETUTORING.COM

Subject(s) : __________________________________________________________________

(Subjects mastered) __________________________________________________________________

Teaching Schedule : Monday At : __________________________________

(Put check-list on the empty box
provided based on your day
availability in teaching and the
detail of teaching hours. Ex: At 4
pm – 7 p.m)
Tuesday At : __________________________________
Wednesday At : __________________________________
Thursday At : __________________________________
Friday At : __________________________________
Saturday At : __________________________________
Sunday At : __________________________________

Transportation : Motorcycle/Car/Public Trans./ Other_______________*(write)

Students Location Preferences :____________________________________________________________

Minimum Expected Fee : IDR _____________________________/meeting.

Status : Part time tutor / Full time tutor *)

Where do you know about us ? : Friends/FB/IG/ Website/other (*write)

REGISTRATION DISCLOSURE STATEMENT

I hereby certify that statement and information in this registration form are true and
correct to the best of my knowledge and belief, and I authorize the Groovy Excellent
Education to investigate all statements or other information contained in this
registration form and any attachment submitted with it, unless I have stated wrong in
contrary.
The mediocre teacher tells. The good teacher explains.
The superior teacher demonstrates. The great teacher inspires. 3
-William Arthur Ward-
TUTOR REGISTRATION FORM
WWW.GEETUTORING.COM

I understand and agree that:

1. Any misinterpretation, falsification or material omission of any information
on this registration form may result in my failure to receive an offer, or, if I
am hired, in my dismissal from my employment
2. All offers of employment are conditioned on the provision of satisfactory
proof of an applicant’s identity and legal authority to work in Groovy
Excellent Education
3. An investigation may be made during the processing of this registration form,
and I authorize any of the persons or entities referred to in this registration
form to provide any and all information concerning my previous employment
(s) or the other statements I have made in connection with this application

(Your city name), ________________________

(Your complete name as written at KTP)

The mediocre teacher tells. The good teacher explains.

The superior teacher demonstrates. The great teacher inspires. 4
-William Arthur Ward-