First Name

Last Name

Email address

Mobile Number

Date of Birth

Address

Address

Town / City

Country

Postal Code

How did you find us? How did you find us? Google Facebook Word of Mouth Other

Do you speak fluent English? Do you speak fluent English? Yes No

What other language (s) do you speak?

Are you a qualified Are you a qualified Teacher Coach Child care worker Tefl / Esl Teacher or Tutor None of the above

Do you have any criminal convictions spent or unspent Do you have any criminal convictions spent or unspent Yes No

If yes, please explain

Are you barred from working with children or vulnerable adults? Are you barred from working with children or vulnerable adults? Yes No

Employment Status Employment Status Employed Unemployed Self-employed

Current Job

If employed, who do you work for?

Job Description

What qualifications do you have?

Do you have any experience working with children? Please provide details and the ages of the children you have worked with.

What inspired you to want to teach Emotional Intelligence skills?

Tick to agree to the following Tick to agree to the following I understand that I have to complete the EQ Tutor Training and pass the assessment before I can teach

Tick to agree to the following Tick to agree to the following I understand that I need to submit a police clearance / DBS certificate before I can teach

Tick to agree to the following Tick to agree to the following I understand that this is an opportunity to work with us and not an offer of employment

Tick to agree to the following Tick to agree to the following I am interested in becoming an EQ Tutor and am willing to pay for my training