ES
Student Preferences Selection
(To be filled
out by ES and ES Recruiter when ES is selected)
Fax completed form to ES Support at 760-248-3330 or mail
to 8560 Aliento Rd,
1. Desired student load: ________
(10 maximum if ES has another full-time job, 25 maximum
for a full-time new ES)
2. If needed, I am willing to travel
_______ miles one-way to serve students.
(We make every attempt to keep mileage under 25 miles
round trip, but for growing areas this is not always possible.)
3. Gender preference (circle):
None Female students only Male Students only
4. RSP/ES: Number of RSP students you are willing to serve
_______ (18 is max.)
(Include this number in #1 above. RSP students you provide weekly services for
will count as 2 regular students in your total desired count.) Credential: ________________________________________________
5. If part-time, other employment you plan to continue concurrently with us (Provide name of employer and location):
____________________________________________________________________________________________
I understand that I am being interviewed for a position as an ES for
the above school based on my willingness to accept the type of students
indicated above in my ES load. I also
understand that if I feel overwhelmed, I am free to lower my student count upon
request at any time to a minimum of 10 students, serving my present students
until they can be placed with another ES.
Date: _____________
ES Name: _____________________________ Signature: ________________________
ES Recruiter Name: ______________________Signature:
________________________
For Office Use Only:
Information entered into
database: Date_____________________ By __________________________