Private Lesson Paperwork Checklist

Transcription

1 Private Lessn Paperwrk Checklist Please cmplete the fllwing frms t be eligible t teach as a Private Lessn Instructr fr 2018/19. General Infrmatin Frm Cnsent t Perfrm Criminal Histry Backgrund Check in Cmpliance with the FCRA Yu must fill in yur Driver s License # and address. Private Lessn Prgram Applicatin Please fill in cmpletely, this infrmatin is used t assign yur instructr fee level. Private Lessn Prgram Instructr Agreement Bdily Injury & Prperty Damage Waiver Yu will be ntified via by the Fine Arts Department when yu are apprved t teach. D nt schedule any students befre yu have been apprved. Yur apprval will include: Ntificatin that yu are being added t the apprved Private Lessn Instructr list fr 2018/19. Yur assigned instructr fee level that dictates the maximum fee yu may charge fr lessns. The 2018/19 Campus Directrs Cntact List s that yu may cntact music directrs and find eligible students. Nte t returning instructrs: yu will nt be apprved t teach if yu have an utstanding balance due n yur usage fees frm 2017/18. Thse fees will need t be paid in full befre yu can teach. This packet f frms nly allws yu t wrk as a Private Lessn Instructr. Shuld yu wrk as a Clinician paid by the district, a separate set f Purchasing Frms will need t be cmpleted at that time.

2 Fine Arts Department GENERAL INFORMATION Name: (Last) (First) (MI) Will yu abide by the safety rules f the district? Yes N Have yu ever been cnvicted f any crime? (Includes DWI) Yes N If the answer is yes please explain: Have yu ever been cnvicted f a felny r any crime invlving mral turpitude?* Yes N If the answer is yes please explain: Have yu ever been cnvicted f a felny r any crime invlving mral turpitude and received prbatin? * Yes N If the an swer is yes pleas e explai n: Has any curt ever received a plea f guilty r a plea f nl cntendere frm yu fr any ffense? ** Yes N Has any curt ever deferred prceeding withut entering a finding f guilty and placed yu n prbatin?** Yes N (this includes deferred adjudicatin) Has any curt ever placed yu n prbatin fr any ffense?** Yes N If the answer t any f these three questins is yes, please explain: * Mral turpitude is defined as act f business, vileness, r depravity in the private and scial duties which a persn wes anther member f sciety r sciety in general and which is cntrary t the accepted rules f right and duty between persns. Crimes invlving turpitude include, but are nt limited t, theft, attempted theft, murder, rape, swindling, and indecency with a minr. ** The district will review the nature f the ffense, the date f the ffense, and the relatinship between the ffense and the psitin fr which the persn is applying befre making a determinatin. Signature

3 CONSENT TO PERFORM CRIMINAL HISTORY BACKGROUND CHECK IN COMPLIANCE WITH THE FCRA (Fair Credit Reprting Act) I am an applicant fr emplyment with the Katy Independent Schl District (the District) and have been ad ised that, as part f the applicatin prcess, the District will cnduct a criminal histry backgrund check. I d hereby cnsent t the District s use f my infrmatin prvided during the applicatin prcess in perfrming the criminal histry check. The District has infrmed me that I have the right t review and challenge my negative infrmatin that wuld adversely impact a decisin t ffer emplyment. In additin, I have been infrmed that I will have an pprtunity t clear up any mistaken infrmatin reprted within a reasnable time frame established at the sle discretin f the District. In cm pliance with the Fair Credit Reprting Act, I have been advised that, upn request, I will be prvided the name, address and telephne number f the reprting agency as well as the nature, substance, and surce f all infrmatin. Last Name First Name (per birth certificate) Middle (per birth certificate) Last Name (per birth certificate) Address City State Zip TDL / / / / Scial Security Number Sex Race f Birth Are yu a Katy ISD Emplyee? Are yu retired frm Teacher Retirement System f Texas? / / f Retirement PLEASE COMPLETE THE INFORMATION REQUESTED BELOW FOR ALL LOCATIONS OF RESIDENCE SINCE THE AGE OF 18, YOU MUST BE SPECIFIC ABOUT DATES: City/Twn Cunty State Year Fr Year T (Please use a separate sheet, if necessary, t prvide cmplete infrmatin) I hereby certify that all infrmatin prvided in this authrizatin is true, crrect and cmplete. I understand that if any infrmatin is fund t be incrrect r incmplete, it may be grunds fr cancellatin f my r all ffers f emplyment r grunds fr terminatin f emplyment at the discretin f the District. Signature Phne Number Persnnel Office Use Only Wincular Cert Admn Par/Tec Sub Other(Aux) Results: FI/OS Archi e Nat l Name f the campus and the directr submitting this applicatin: Please print Revised/FIne Arts 06/10/2015

4 Katy ISD Private Lessns Prgram Applicatin fr Private Lessns Instructr Persnal Infrmatin First year at Katy ISD: yes n Name: f Birth: Last First Middle Address: Street/PO Bx Apt City State Zip Telephne Numbers: Other Infrmatin: Hme: Cell: Scial Security Number: Address: Instrument: 1st Chice: 2nd Chice: Please Circle yur highest level f cmpleted educatin: High Schl/Nn-Degreed Bachelr Master Dctrate Institutin attended: Please list yur teaching experience: (mst recent first) Name f Schl District/Schl Frm T Instrument Taught Please Circle ttal years f teaching listed abve: 1-4 years 5-9 years years 15 + years Persnal References: (Include 3 Peple ther than relatives, wh have knwledge f yur character, persnality and wrking ability.) Name Years Knwn Phne Number In signing this applicatin, I certify that ALL the infrmatin prvided by me in cnnectin with my applicatin, whether n this dcument r nt, is true and cmplete, and I understand that any incrrect misrepresentatin, r missin f infrmatin shall be grunds fr refusal t hire r, if hired, terminatin. I als agree t give Katy ISD authrizatin t cntact all references, and emplyers referenced in this applicatin. Signature ffice use nly: Apprved Teacher Payment Level: reviewed/apprval date:

5 Katy ISD Private Lessns Prgram (PLP) Instructr Agreement I,, as a Private Lessn Instructr (PLI) in the Katy Independent Schl District, d agree t the fllwing terms t satisfy district prcedures regarding the individual instructin f students in Katy ISD facilities: 1) PLIs are t wrk with students t develp their individual music perfrmance skills and t enrich the instructin being delivered in the student s music class. Lessns instructin times are nly t be scheduled fr students in grades 6-12, wh are currently enrlled in Katy ISD band, chir, r rchestra classes. 2) Instructrs are nt t exceed their KISD apprved level amunt per 30 minute lessn. Level 1 = 18.50; Level 2 = 20.50; Level 3 = 22.50; Level 4 = ) An amunt f $.50 (cents) fr each 30 minutes f lessns cmpleted (r unexcused lessn), will be remitted t Katy ISD fr Facility Usage and Administrative Fees. (Invices will be sent ut at the end f each mnth. Failure f the instructr t pay Katy ISD the inviced amunt in usage fees will result in yur services being terminated as an apprved cntracted PLI.) 4) PLI is respnsible fr the cllectin f all lessn fees frm students including the custmary 4 lessn depsit at the beginning f the year. The Katy ISD Private Lessn Prgram strngly encurages instructrs t cllect fees in advance at the start f each mnth. Cllectin f student fee transactins are strictly between the Private Lessn Instructr and student. 5) Accurate reprting f all fees cllected fr instructin (level amunt per lessn and the business cst deductin f $.50 cents per lessn) is the respnsibility f the instructr fr tax (IRS) purpses. 6) A Fine Arts PLP Student Attendance Recrd frm will be cmpleted each day by instructr fr lessns prvided. Frms will be used fr Facility Usage and Administrative Fee billing, and tracking attendance f students and facilities. Any falsificatin f lessns given, excused, r unexcused is just cause fr dismissal f an instructr frm the Katy ISD Private Lessns Prgram. 7) Katy ISD will prvide the names f all Private Lessns Prgram Instructrs t all campus directrs. Instructrs may ntify the Private Lessns Prgram ffice in the event f an pening in a lessn time. Fine Arts ffice will ntify campus music prgrams f the pssibility f scheduling any students waiting fr lessns. 8) Lessns are available nly t thse students presently enrlled in Katy ISD music prgrams Band, Chir, and Orchestra. (grades 6 th 12 th nly) Signature f Instructr: : Michael Ouellette, Executive Directr f Fine Arts

6 Katy Independent Schl District Bdily Injury and Prperty Damage Waiver BE IT KNOWN, fr gd cnsideratin, the undersigned, Releasr: Name f Releaser Street Address f Releaser City, State, Zip f Releaser Jintly and severally hereby frever release, discharge and acquit Releasee: Katy Independent Schl District 6301 S. Stadium Lane Katy, TX Frm any and all cntracts, claims, suits, actins r liabilities bth in law and in equity specifically arising frm, relating t r therwise described as and limited t: Event leading t release T prvide services at any Katy ISD facility as a private lessns instructr fr the academic year. f Original Cntract This release applies nly t the freging matters and extends t n ther debt, accunt, agreement, bligatins, cause f actin, liability r undertaking by and between the parties, which, if existing, shall survive this release and remain in full frce and effect and undisturbed by this specific release. This release shall be binding upn and inure t the benefit f the parties, their successrs, assigns and persnal representatives as fllws: Printed Name Cntractr Psitin Schl/Department Official Signature f Releaser Signature f Katy ISD Administratr CJ (R)(E) F Revised: