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Community Synergy Tutoring, Inc.

GOOD MORAL CHARACTER STATEMENT OF ASSURANCE


Community Synergy Tutoring (CS Tutoring) standards require that any applicant for tutorial employment be deemed to be of good moral character. These standards are embodied in the governing principles of CS Tutoring. CS Tutoring is responsible for ensuring the recruitment and retention of qualified education professionals of the highest standard, inclusive of Good Moral Character whom will administer quality academic services to our clientele. Given this responsibility, it is required that you sign this statement regarding good moral character as a prerequisite of employment consideration by Community Synergy Tutoring. Read the standards and the questions listed below. If you meet the standard, sign the assurance of good moral character in the first signature block of this document. If you can accurately and honestly answer NO to all of the questions, sign the second signature block statement. Be aware that failure to sign this form or to respond truthfully may jeopardize your eligibility for employment. Good moral character is defined below as follows: A person shall be deemed to be of good moral character provided that said individual has not pleaded guilty to or been convicted of any felony, any violation regarding the corruption of a minor or any sexual imposition offenses, any offense of violence, theft offense, or drug abuse offense that is not a minor misdemeanor. All applicants for CS Tutoring employment are required to answer the following questions: 1. Have you ever been convicted of, found guilty of, pled guilty to or pled no contest to any misdemeanor other than a traffic offense? Yes No 2. Have you ever been convicted of, found guilty of, pled guilty to or pled no contest to any felony? Yes No 3. Have you ever had a criminal conviction sealed or expunged? Yes No

4. Have you ever had ANY [professional] certificate, license, or permit, or an application for same, revoked, suspended, limited, or denied? Yes No 5. Have you ever surrendered ANY [professional] certificate, license, or permit? Yes No

Community Synergy Tutoring, Inc.

If you meet the standard for good moral character as defined in paragraph three of this document, please sign the following assurance of good moral character:

I, ________________________________, assure Community Synergy Tutoring that I am of good moral character, as defined in the third paragraph of this document.

___________________________________________________________________ Date 1st Signature Block Signature

If you can accurately and honestly answer NO to all of the questions listed in paragraph four, please sign the following statement:

I, ________________________________, assure Community Synergy Tutoring that I can accurately and honestly answer NO to all of the questions listed in paragraph four.

________________________________________________________________ Signature Date 2nd Signature Block

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