Class Checking Application Name:* First Last Home Phone Number:*Cell Phone Number:*Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email:* Classification:* Freshmen Sophomore Junior Senior Graduate Student Graduate Student on Assistantship Part Time Faculty Full Time Faculty Are you on an assistantship?* Yes No Number of hours:*AVAILABILITYThe Rankin Smith Center will be available for tutoring during the following times: • Sun. 5pm-10pm • Mon-Thurs: 7am-10pm • Fri. 7am-4:30pm How many hours per week are you available to work?**Please note that if you are on an assistantship, you cannot exceed 20 hours per week. Please indicate the times in which you are available to work each day: (example: 1-5 PM)Sunday:*Monday:*Tuesday:*Wednesday:*Thursday:*Friday:*PERSONAL HISTORYHave you ever been charged with or subject to disciplinary action for scholastic or any other type of misconduct at any educational institution?* Yes No Please explain.*Have you ever been charged with a violation of the law which resulted in probation, community service, a jail sentence, or a revocation or suspension of your driver’s license?* Yes No Please explain.*DISCLOSUREWe consider it a conflict of interest for a tutor to work with a student-athlete with whom they have a prior social relationship. While a prior relationship will not exclude you from employment at the Rankin Smith Center, prior relationships need to be documented. Prior Relationships include (but are not limited to): social relationships (short and long term), romantic relationships (short and long term), family members, former teammates, RA’s, TA’s, GA’s, co-workers, team managers, and roommates. If you have a question about a prior relationship, please document it below and speak with a coordinator. Part I :* I have NOT had a prior relationship with any student-athlete (past, present, or incoming) at the University of Georgia. I HAVE had a prior relationship with a student-athlete (past, present, or incoming) and understand that I am required to honestly document that relationship below. Please explain your prior relationship with the student-athlete. (List their name and the nature of the relationship).*Part II :* I have NOT had a prior relationship with any coaches, support staff members or UGAA related organizations or departments (past or present) at the University of Georgia. I HAVE had a prior relationship with a any coaches, support staff members or UGAA related organizations or departments (past, present, or planned) and understand that I am required to honestly document that relationship below. Please explain your prior relationship with a coach, support staff member or UGAA related organization or department member. (List their name and the nature of the relationship).*I will notify the Coordinator in the event of any change in relationship status. I understand as an hourly employee of the Rankin Smith Center, any violation of the UGAA Professional Ethics Policy* could result in immediate termination.* I agree. *The UGAA Professional Ethics Policy is located in Handbook.Have you previously been employed by the University of Georgia Athletic Association?* Yes No What was your previous position within the Athletic Association?*ACKNOWLEDGEMENTWith my signature, I grant the Athletic Academic Support staff the right to review my academic records in order to verify information given, such as my GPA.*Date:*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Δ
