Music Teacher Application

Name:

Date of Birth:

Last 4 digits of SSN#

Address:

Home Phone:

City, State, Zip:

Daytime Phone:

Cell Phone:

Email Address:

I am available to teach... (check all that applies):
Monday	All Day	9:00	10:00	11:00	12:00	1:00	2:00	3:00	4:00	5:00	6:00
Tuesday	All Day	9:00	10:00	11:00	12:00	1:00	2:00	3:00	4:00	5:00	6:00
Wednesday	All Day	9:00	10:00	11:00	12:00	1:00	2:00	3:00	4:00	5:00	6:00
Thursday	All Day	9:00	10:00	11:00	12:00	1:00	2:00	3:00	4:00	5:00	6:00
Friday	All Day	9:00	10:00	11:00	12:00	1:00	2:00	3:00	4:00	5:00	6:00
Saturday	All Day	9:00	10:00	11:00	12:00	1:00	2:00	3:00	4:00
Sunday	All Day					1:00	2:00	3:00	4:00

Date Midbell can begin scheduling students for me:

My primary instrument(s)

My secondary instrument(s)

I play or have played in the following performing group(s) or ensemble(s):

Education Background:

Degree	Institution	Field of Study
High School Diploma		-----------------
Associate (2-year)
Bachelor (4-year)
Master/Graduate
Phd
Other
Other
Other

FORMAL TEACHING EXPERIENCE (INFORMAL experience such as home studios and subbing jobs are to be listed on the next page):

School/Institution Name	Ensemble(s)	Time Period
Example: XYZ School District	MS/HS Band, HS Choir	1995-2001
Example: Main Street Music School	Private sax lessons, Group guitar	2000-2003

INFORMAL TEACHING EXPERIENCE (please explain):

I WOULD BE INTERESTED IN TEACHING (Check all that apply):

Lesson Type	Beginner	Intermediate	Advanced
Private Accordion
Private Bass (Guitar)
Private Bass (Upright)
Private Cello
Private Clarinet
Private Double Reeds
Private Drum Set
Private Flute
Private Folk Instruments
Private Guitar
Private Harmonica
Private Horn in F
Private Jazz Improv
Private Percussion
Private Piano/Keyboard
Private Recorder
Private Sax
Private Trombone
Private Trumpet
Private Tuba/Euph
Private Viola
Private Violin
Private Voice
Group Guitar
Group Jazz Improv
Group Piano/Keyboard
New Horizons Band
Jazz Big Band
Orchestra Ensemble
Other
Other
Other
Other

I prefer the following method book(s) for the students that I teach:

Ray's Mid-Bell Music will be compiling a bio of each teacher so that potential students and/or parents can read about who is available for lessons in the Learning Center.

Please check one of the following... "If I were to be selected as an Independent Contractor for the Ray's Mid-Bell Music Learning Center, I would prefer":

To write my own brief biography (below)

To have Mid-Bell assemble a brief biography for me based on the info in this application.

Thank you for taking the time to apply with us!

IMPORTANT NOTICE

A BACKGROUND CHECK AND/OR CREDIT REPORT is required prior to hiring as Independent Contractor. This notice is in compliance with federal fair credit reporting act sections 604(a)(3)(A). I hereby authorize Ray's Mid-Bell Music to procure a background check and/or credit report.

Enter your name for Online Signature

I hereby authorize Ray's Mid-Bell Music to procure a background check and/or credit report.

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