1. RIGHT START TUTORS (RST)
PO BOX 13345
BIRMINGHAM
B11 9BR
Mobile:07825040273 EDUCATIONAL SERVICES
Fax:0871 253 4455 email:fs12@fsmail.net
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APPLICATION FORM
Surname:_________________________________________________________ Title:__________________
Forenames:_________________________________________________Previous names:___________________
Address:____________________________________________________________________________________
_______________________________________ Postcode:______________ Tel No:______________________
Mobile No:______________________________ E-Mail:____________________________________________
Maritial Status:_____________________ Ages of children:__________________________________________
Nationality:_________________________Date of Birth:__________________Age last birthday:___________
How long have you lived a) in the UK?:_______________b)at your present address?___________________
Subject/levels you can offer. List in order of preference:
Subject (s) Level (s)
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________________________________________________ __________________________________________
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Are you prepared to tutor How far are you prepared to travel?______________miles
a) In your own home? Yes/No Days available: Mon Tues Wed Thurs Fri Sat Sun (circle)
____ ____ ____ ____ ____ ____ ____
Times available:____ ____ ____ ____ ____ ____ ____
b) In the pupils home? Yes/No (write under ____ ____ ____ ____ ____ ____ ____
days) ____ ____ ____ ____ ____ ____ ____
Please state your academic
qualifications:_________________________________________________________
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____________________________________________________________________________________________
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University,Polytechnic,College attended:_________________________________________________________
____________________________________________________________________________________________
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If you are teaching at present give details:
Name and address of establishment:_____________________________________________________________
__________________________________________________________Your position______________________
This information will be kept in strictest confidence and we will only contact the establishment with your
permission.

2. Explain your present circumstances and list your experiences in teaching, tutoring and
other employment:
____________________________________________________________________________________________
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REFERENCES
Please give the name of two referees (one of whom should be your current or more recent employer)
Name:_______________________________________ Name:_________________________________________
Address:_____________________________________ Address:_______________________________________
___________________________Postcode:_________ __________________________Postcode:____________
Phone:______________________Fax:_____________ Phone:______________________Fax:______________
Email:_________________ Email:____________________
Relationship to you:____________________________ Relationship to you:_____________________________
CV enclosed Yes/No Dfee/DES/DfES Reg No :( if applicable) ____________
Is there anything in your past history which would disqualify you from being placed in a position of trust with
children and young adults? Yes/No
Have you ever been convicted of a criminal offence, been bound over, received a caution, judgement or
investigation pending against you, including spent convictions? Yes/No
If yes supply details on a separate sheet which will be treated in confidence (complies with the rehabilitation of offenders act 1974.)
__________________________________________________________________________________________________________________________________________
DECLARATION
a) I understand a relevant Criminal Records Bureau Enhanced is needed. (you will receive more advice on this)
b) I am in agreement with the aims of RST and with its statement of Principles and Code of Professional
Conduct. My conduct, whilst tutoring for RST will reflect this trust. I will be concerned for my
pupils and endeavour to give them good service.
c) I understand that RST will not be held responsible for any injury, loss, accidental damage, personal
indictment or any other claim whatsoever arising in connection with tutoring assignments.
d) I promise to forward my commission on the sixth of each month in accordance with the guidelines
provided on the scale of charges. I understand clients are informed that their commission included in
the total fee will be paid to RST by the tutor.
e) I understand that I am legally required to hand on all collected commission and will be charged
interest and agency costs in recovering any due amount. (see terms and conditions)
f) I understand commission is payable on all direct, indirect and declared clients registered with RST
and commission is due on all those clients whether they are taught continuously or after a break of
any length.
g) I enclose required documents as specified in the enclosed ‘Documents to be forwarded’ letter.
h) I have completed this application form honestly.
i) I agree with the Terms and Conditions enclosed.
Signed:________________________________________________ Date:_____________________
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For office use:_____________________________________________________________________________