Independent Contractor Class Instructor Application

Instructor Name:

Email:

Address:

Street:

City:

Zip:

Day Phone:

Evening Phone:

Classes/topics I am qualified to teach:

Related Educational Background:

Related Experience

Agency:

Title:

From:

To:

Description of duties:

Specialized Training:

Fluency in other Languages:

Have you ever been convicted of a felony, or, within the past two years, a misdemeanor which resulted in imprisonment:
NoYes

If yes, please explain:

Professional References

Name:

Organization/Company:

Phone Number:

Personal References

Name:

Organization/Company:

Phone Number:

I certify all statements on this application are true and complete to the best of my knowledge. I hereby authorize the City of Rialto to investigate any information contained in this application. I understand false or incomplete statements my be cause for disqualification or dismissal of contract.

Date:

Select Date

Notice:

Upon Approval:

A contractual agreement must be entered into between the City and the Instructor.
All instructors must be fingerprinted prior to teaching any classes.
All sub-contractors must be listed on the contract, and must be fingerprinted.

Reset

Top Image
Bottom Image
Bottom Padding	361
Total Height (Optional)
Background Color	bce6b7
Dark Background