Application form Thank you for applying to be an ESOL home tutor with English Language Partners. Select a centre*Select a centreWhangareiNorth ShoreAuckland WestAuckland CentralAuckland SouthTaurangaHamiltonRotoruaTaupoNew PlymouthNapierWanganuiPalmerston NorthLevinPoriruaLower HuttWellingtonNelsonBlenheimChristchurchTimaruDunedinInvercargillName* First Last Contact phone (home)Contact phone (work)Contact phone (mobile)Email* Address* Street Address Address Line 2 City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Date of birth DD MM YYYY Gender*MaleFemaleAre you a NZ Citizen / Permanent Resident of NZ?*YesNoEthnicity*First language*Other language(s)Work status*Full timePart timeStudentHomemakerSelf-employedRetiredUnemployedOtherPresent occupation*Past occupationsDays/times available*Mode of transport to learner*Life experience (i.e. family, travel, work, qualifications)*Personal interests and preferences (e.g. ethnicity, language level, do you mind if children are present at lessons?)*How did you hear about English Language Partners?*AdvertisementFacebookEmailWebsiteWord of mouthOther ESOL home tutorConnecting Cultures magazineLocal paperVolunteer centreI agree to provide the names and contact addresses / phone numbers of two people (other than family members) who are able to act as my referees.Referee 1:NameAddressPhoneEmail What is your relationship with this referee?Referee 2:NameAddressPhoneEmail What is your relationship with this referee?(Tick to agree)* I give permission for English Language Partners New Zealand to hold the above information about me in accordance with the Privacy Act, 1993, and understand that some details will be passed on to the National Office for accountability purposes for Government funding and for general communications. I may see any information held about me and amend any errors in that information. * I give permission for my contact details to be used by English Language Partners to inform me of its activities relating to my work as a volunteer home tutor. I understand English Language Partners will not pass contact details to any other organisation. * I have declared any criminal convictions (not excluded by the Clean Slate Act 2004) and/or any criminal charges pending in New Zealand or any other country. * I understand my application may be declined and that this decision is final. * I understand that there may be a one-off charge of $40 to cover course book and materials costs. * I confirm the information I have provided is correct. Statutory information statement for students required under section 234B of the Education Act: There is a $40NZD fee for this course to cover training materials etc. Check your centre's webpage for details. No governing members of English Language Partners New Zealand have potential or material conflicts of interest.