ST. AMBROSE PREPARATORY SCHOOL
                       HALE BARNS, ALTRINCHAM, CHESHIRE WA15 0HF
                       Tel. No.: 0161 903 9193                                 FAX No.: 0161 903 8138

Please complete this form in black ink (for photocopying) and return to the Headmaster’s secretary.

POST APPLIED FOR _______________________________________________________

PERSONAL DETAILS (Block Capitals please)

Surname _________________________________ Forenames __________________________________

Title _____________ Marital Status ________________ Religious Affilliation ____________________

Present Address

____________________________ Postcode __________________ Tel. No. _______________________

DFES Ref. No. _________________________________ N.I. No. ________________________________

Would this be your first teaching post? __________________ If not, state when and with which LEA

your probationary period has been completed satisfactorily ___________________________________

Date when free to start _________________________________

Particulars of any absences exceeding 2 weeks due to illness in last 2 years _______________________



Designation of Post _______________________________ Type of School ________________________

Name & Address of School

_________________________ Postcode __________________ Tel. No. __________________________

Date of Appointment (a) to School _______________ (b) to Present Post (if different) _____________

Employing Authority _________________________________ Full or Part Time __________________

Salary Scale:

Present Basic Salary __________________ Additional Allowances (London, SPA etc.) _____________
            School                 LEA         Dates     Full/Part   Post Held     Ages             Subjects
(Indicate type, no. on roll and             Month/Year    Time                    Taught            Taught
single/mixed sex)                           From To


Secondary School(s) attended (with dates) __________________________________________________

GCE ‘O’ Level/GCSE or equivalent passes (subjects and year of passing) _______________________

GCE ‘A’ Level or equivalent passes (subjects, grades and year of passing) _______________________


                University and/or College                   Full or Part Time        From                To

   Degree(s) and Certificate(s)            Principal           Subsidiary          Honours,             Date
      Designation and Type               Subject/Area           Subject          Class Dist. etc.

Ring the ages you are specifically trained to teach: 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
State subject(s) you are qualified to teach:
Main subject(s) ________________________________________________________________________________

Subsidiary subject(s) ___________________________________________________________________________
COURSES ATTENDED (include all courses of 60 hours or more and any short course in last 3 years)
           Course                     Organising        Date               Course                 Organising           Date
                                        Body                                                        Body

NON-TEACHING EMPLOYMENT in chronological order, please.
 Nature of Employment                    Name of Employer (and address of present                           Dates
                                                 employer, if appropriate)                          From              To

REHABILITATION OF OFFENDERS ACT 1974 (This section must be completed by all applicants)

Because of the nature of the work for which you are applying this post is exempt from the provision of Section 4(2) of the
Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975.
Applicants are, therefore, not entitled to withhold information about convictions which for other purposes are ‘spent’
under the provisions of the Act, and, in the event of employment, any failure to disclose such convictions could result in
dismissal or disciplinary action by the Authority. Any information given will be completely confidential and will be
considered only in relation to an application for positions to which the order applies.

Please state whether or not you are affected by the above statement, indicating Yes or No ____________
If the answer if ‘Yes’ details should be given in a sealed envelope and enclosed with this application.

DISABLED PERSONS (Employment) Act 1949
Please state whether you are registered as a disabled person. Yes/No ____________________

If ‘Yes’, please give details on a separate sheet.

References in all cases will be made to your present employer. Please give the name of two additional

Name ____________________________________ Name _______________________________________

Address __________________________________ Address _____________________________________

______________ Post Code ______________                            _____________ Post Code ________________

Tel. No.: ______________________________                           Tel. No.: _______________________________

Status ________________________________                            Status _________________________________
LETTER OF APPLICATION (not exceeding 250 words)

I certify that the information given on this form is correct and complete to the best of my knowledge.

Signature of Applicant ___________________________________             Date _____________________

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