Independent Contractor Application

Right Advice. Right Brands. Real Value.
Independent Contractor Application for Music Teachers

To the applicant: Thank you for your interest in our organization. Your application will
receive consideration without regard to race, creed, color, sex, age, national origin,
disability, or any other protected class status. To enable us to properly and fairly
evaluate your application, please answer all of the questions as carefully and completely
as possible.
Personal Data
Name______________________________________________________________________________
Address____________________________________________________________________________
Home Telephone Number (
) ________________ Work Number (
) _________________
Do you carry your own Worker's Compensation coverage? _________Yes ________No

Do you carry your own General Liability coverage? _________Yes ________No
Your Education
Name
City/State
Yrs.
completed Graduate? Degree
College
Graduate School
Other Special Training
List any scholastic honors, awards

_____________________________________________________________________________________
Describe any other school or specialized training
_____________________________________________________________________________________
Major in college ________________________Major instrument_____________________________
Minor in college ________________________Minor instrument ____________________________
2011 Schmitt Music Company
Independent Contractor Application for Music Teachers - page 2

Teaching History
Please provide information covering your teaching history. Cover your last three positions.
Organization/School ______________________________________________Dates______________
Address _____________________________________________________________________________
City____________________________________________State __________ Zip __________________
Address _____________________________________________________________________________
City____________________________________________State __________ Zip __________________
Address _____________________________________________________________________________
City____________________________________________State __________ Zip __________________
If you worked in any of your previous positions under another name, please give that
name below (for reference checking purposes)
Teaching References
List people for whom youve worked (or taught) who have personal knowledge of your
character, experience, and capability. If you have a limited teaching history, you may also
list teachers, advisors, or college professors who know you. (We must be able to reach at
least three references).
Name________________________________________________________________________________
Address _____________________________________________________________________________
Telephone____________________________________________________________________________
Organization/School__________________________________________________________________
Independent Contractor Application for Music Teachers - page 3

Teaching References (continued)
Name________________________________________________________________________________
Address _____________________________________________________________________________
Telephone____________________________________________________________________________
Name________________________________________________________________________________
Address _____________________________________________________________________________
Telephone____________________________________________________________________________
Name________________________________________________________________________________
Address _____________________________________________________________________________
Telephone____________________________________________________________________________
ACKNOWLEDGEMENT: I grant permission for the Company to investigate my references,

and I authorize my references to provide any information to the Company that they
deem appropriate.
Signature _______________________________________________ Date ______________________

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Right Advice. Right Brands. Real Value.

Independent Contractor Application for Music Teachers

) ________________ Work Number (

Do you carry your own Worker's Compensation coverage? _Yes No

List any scholastic honors, awards

2011 Schmitt Music Company

Right Advice. Right Brands. Real Value.

Independent Contractor Application for Music Teachers - page 2

2011 Schmitt Music Company

Right Advice. Right Brands. Real Value.

Independent Contractor Application for Music Teachers - page 3

ACKNOWLEDGEMENT: I grant permission for the Company to investigate my references,

Signature _________________________ Date

2011 Schmitt Music Company

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