Apply for Test Preparation: MCAT Instructor

Please fill out the form below and click "Submit" to submit your application for consideration. Fields with an asterisk (*) are required. To avoid losing your work and to take advantage of saving your answers and finishing the application later, we recommend routinely clicking the "Save & Finish Later" button at the bottom of the page. We look forward to hearing from you.

Summary
Title:Test Preparation: MCAT Instructor
ID:1238
Area of Interest:Education and Community Outreach
Contact Information
* First Name* Last Name

* Country

* Home Street Address
Street address, P.O. box
Apartment, suite, unit, building, floor, etc

* City* State* Postal Code
* City* Other Principal Subdivision
City or town name
Province, state, county, region and/or postal code


* Preferred Phone Number
()- Ext.
Enter numbers only, no dash or parenthesis

* Email Address

Professional Website or LinkedIn Profile

Application Information
* Referral Source:
* Areas of Specialization:
Courses Qualified to Teach:
* Available for Client-Based Instruction: Yes    No   
Are you available for local travel (within San Diego County) to teach at a client's site?
Attachments
* Resume (or Biobib for UC faculty):
Supported formats: Word, PDF, RTF, Text, and HTML.
  - or Upload from:
 
GENERAL INFORMATION
* Please provide your name.
* Are you authorized to work in the United States?
Yes
No
* Are you related to someone who currently works at UC San Diego?
Yes
No
If yes, please provide your family member's name and department where they are employed.
* Are you currently or have you ever been employed by the University of California?
Yes
No
If yes, please provide your employee ID.
If yes, please list the UC campuses and departments at which you have been or are employed in any capacity, as well as the dates of your employment. If you have a current academic appointment, please indicate this here. If you are a UC retiree, please indicate this here.
* Are you currently or have you ever been an instructor or guest speaker at UC San Diego Division of Extended Studies?
Yes
No
If yes, how are/were you paid?
Payroll (W-2)
MarketPlace (1099)
Other/Unknown
* Are you currently an undergraduate student, a graduate student, or a post-doctoral scholar at any University of California campus?
Yes, undergraduate student
Yes, graduate student
Yes, post-doctoral scholar
No
If yes, please provide your student ID.
* Are you currently or have you ever been a student at UC San Diego Division of Extended Studies?
Yes
No
PROFESSIONAL EXPERIENCE

Education

* Do you have a graduate degree?
Yes
No
* If yes, please list your degree(s) and the granting institution(s). If no, please list your highest level of education and the granting institution.

Current Employment

* Name of Organization
* Location
* Title/Role

Teaching Experience

* Do you have any previous teaching experience? This can include experience as a trainer in a corporation or similar positions/roles.
Yes
No
If yes, please list the number of years and subjects taught, as well as the format (online vs. in-person) and approximate class size.

Related Experience

* Do you have any licenses or certifications related to the instructor position for which you are applying?
Yes
No
If yes, please list the license/certification type, name of the issuing state/professional organization, active/inactive status, and date of expiration.
* Are you an active member of any professional or trade associations related to the instructor position for which you are applying?
Yes
No
If yes, please list the organizations.
* Please briefly summarize your professional experience, accomplishments, and industry involvement and how this relates to the instructor position for which you are applying.
REFERENCES
Please provide contact information for four references. We will contact your references by email. Please be sure to enter an accurate, working email address for each reference and let them know to expect a message from us at that address. We will not be able to evaluate your application without four references and accurate, current contact information for each of them.
Name Title Company Phone Email
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Authorization of Information Release

I authorize the release of information requested by the University of California concerning any Misconduct, as defined below, attributed to me.  

The purpose of this release is to permit the University of California to evaluate such information for employment.

This signed release form authorizes the responsible office(s) at my current or prior institution(s) where I have been employed, to share information related to any Misconduct (including sexual harassment) policy violations attributed to me with the University of California.  

For purposes of this Authorization,

Misconduct is defined as:
         
    • Any violation, or alleged violation, of the policies or laws governing conduct at a candidate’s previous place of
      employment, including, but not limited to, policies or laws prohibiting sexual harassment, sexual assault, or other
      forms of harassment, discrimination, dishonesty, or unethical conduct as defined by the previous employer.  

This authorization includes release of information of a confidential or privileged nature, or any data or materials which have been sealed or agreed to be withheld pursuant to any prior agreement or court proceeding involving disciplinary matters. Should an institution provide information on an incident of misconduct, I will be informed and allowed to provide information in response.

The following are other name(s) that appear on personnel and/or academic records at my current or prior employer(s) which may differ from the name that appears on my University employment application:

Name used and name of employer

I hereby release, discharge, and exonerate (1) the University, its agents and representatives and (2) any institution or employer where I am currently, or have in the past been, employed, or any individual acting on behalf of such institution or employer, furnishing information to the University, from any and all liability of every nature and kind arising out of the furnishing and inspection of such documents, records and other information. This release shall be binding on my legal representatives and successors.

This authorization is valid for 365 calendar days from the date of signature. A photocopy, digital signature, or PDF of this release is to be considered as valid as an original.

* Print Name
* Signature
* Date
AUTHORIZATION

I hereby certify that the facts set forth in this application and any supplemental information, as well as conveyed during any interview which may be granted, is true and complete to the best of my knowledge. I understand that, if employed, falsified statements communicated at any point in the interview process may be considered sufficient cause for immediate discharge. I hereby authorize, to the extent permitted by law, investigation (confirmation) of all statements contained herein, as well as the employers listed above to give you any and all information concerning my employment and any pertinent information they may have, and to release all parties from all liability for any damage that may result from furnishing same.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for UC San Diego Division of Extended Studies to contract my teaching services. As an academic department within UC San Diego, all Extended Studies Program instructors and courses must be formally approved according to the regulations of the Academic Senate of the University of California. Eligibility to teach a course is contingent upon this formal academic approval. Once approved, teaching assignments are by agreement. The instructors Letter of Agreement outlines the deliverables for the course, the course schedule, and compensation terms, and is subject to department policies and procedures. UC San Diego Division of Extended Studies makes no commitment to hire an instructor until it has sent and received a signed instructor Letter of Agreement. Should the course section an instructor plans to teach be canceled for any reason, the instructor agreement, including rights to compensation for future section meetings, is voided. Remuneration is for classroom hours only and does not include time spent for course preparation or other events.

I further understand that I am responsible for being familiar with all rules and regulations of UC San Diego Division of Extended Studies and for abiding by them. I understand that the UC San Diego Division of Extended Studies has complete discretion to modify its policies, rules, regulations and practices at any time, to the extent permitted by federal, state and local law. By submitting this application, I agree to all instructor Terms and Expectations.

* Signature
* Date
Equal Opportunity Employment
The University of California strives to create an inclusive environment for all constituents. As part of this effort, it is important to understand the demographic profile of the entire UC Community. The questions below are voluntary, but sharing this information will provide important and meaningful data regarding the diversity of our employees. Your responses will be kept confidential.

We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.
Gender Identity:
Female
Male
Trans Female/Trans Woman
Trans Male/Trans Man
Genderqueer or Nonbinary Gender
Different Identity
Decline to State
Race/Ethnicity:
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above races
I Choose Not to Respond
Veteran Status: (Please check all that apply)
Individual with a Disability
An individual with a disability is a person who has a physical or mental impairment which substantially limits one or more of such person's major life activities, or who has a record of such impairment.
Vietnam Era Veteran
A person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred - a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5,1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
Disabled Veteran
1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability
War/Campaign/Expedition Veteran
A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized
Armed Forces Service Medal Veteran
A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty
Recently Separated Veteran
Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.
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