Merseyside and Cheshire GTP Consortium by 89hk19S

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									                                          MERSEYSIDE & CHESHIRE GTP CONSORTIUM
                      Covering: East Cheshire, West Cheshire & Chester, Halton, Knowsley, Liverpool, Sefton, St Helens,
                                                                                               Warrington and Wirral


              Assessment Only Application Form – 2012
About This Form
This form can only be completed for applications to the Merseyside and Cheshire GTP Consortium Assessment Only programme.
Please complete the form carefully. The Consortium cannot evaluate your application unless you have provided evidence that you have the
necessary qualifications for the Assessment Only route to gaining qualified teacher status.
The information on the form will be stored on a database and is subject to the Data Protection Act. The application will be confidentially
assessed by a panel of Consortium appointed professional staff who will decide whether you fulfil the entry requirements for the programme.
The form has been designed for clarity of assessment. Each set of questions is followed by a shaded area for assessment. DO NOT WRITE
IN THESE BOXES.
Please read the accompanying guidance before completing the Application Form.
Each Section will be assessed as to your qualification for the programme. Areas of eligibility are clearly marked. If you do not score in these
areas, your application will not qualify. Guidance on particular points is provided within the Sections.
Complete all relevant parts of the form. Questions providing choices should be ticked.
Extra Pages are allowed where requested. DO NOT STAPLE THIS APPLICATION FORM.
Only include extra documents where requested. Do not include original certificates, CV or any other non-requested material.
Please remember to keep a copy of your application.

Part A – Personal Details
Please write in capitals, or type, in black ink.
Title (tick one)                Dr        Mr         Mrs        Miss         Ms                   Other


Forenames


Surname


Former surname
(if different)

Full Postal Address:




Post Code

Telephone Number:                                                              Mobile Number:

E-Mail Address:

Gender                         Male                 Female




MandCGTP Form 020/06/2012                                                                                                                     1/15
Part A – Personal Details (continued)


Date of birth               /          /                  Current age       Years                 Months


Please make sure you give your correct date of birth.




    National insurance Number:


Your National Insurance Number indicates evidence of your eligibility to work in the UK. This must be provided.



Do you have a
                                No                  Yes                 Details:
disability?




Ethnic group

                                              Black or Black British,              Asian, Indian or Asian British,
                White British
                                                         Caribbean                                          Indian
                                                                                       Asian, Pakistani or Asian
                  White Irish         Black or Black British, African
                                                                                                 British, Pakistani
                                                                                    Asian, Bangladeshi or Asian
                White Other                Other Black background
                                                                                             British, Bangladeshi
                                              Mixed, White & Black                      Other Asian background
  Other ethnic background
                                                       Caribbean
                  Not known          Mixed, White and Black African                  Chinese or Chinese British

        Information refused                Other mixed background




Assessment: (do not complete)


                                                                                         Eligible to work in UK




MandCGTP Form 020/06/2012                                                                                             2/15
Part B – Employment Rights

Under UK law all candidates must demonstrate their eligibility to work in the UK.

A complete photocopy of the following documents must be provided with your application form. Original documents
will be required at interview. DO NOT send original documents with your application.

All candidates MUST produce ONE document from List 1 OR TWO documents from either combination of List 2

 LIST 1 – Any one document                                                                                     Please
                                                                                                               
    A passport showing that the holder is a British Citizen, or has a right of abode in the UK
    A document showing that the holder is a national of a European Economic Area country or
     Switzerland. This must be a national passport or national identity card.
    A residence permit issued by the Home Office to a national from a European Economic Area country
     or Switzerland
    A passport or other document issued by the Home Office which has an endorsement stating that the
     holder has a current right of residence in the UK as the family member of a national from a European
     Economic Area country or Switzerland who is resident in the UK.
    A passport or other travel document endorsed to show that the holder can stay indefinitely in the UK,
     or has no time limit on their stay.
    A passport or other travel document endorsed to show that the holder can stay in the UK; and that
     this endorsement allows the holder to teach if they do not have a work permit.
    An application registration card issued by the Home Office to an asylum seeker stating that the
     holder is permitted to take employment.

 LIST 2 – FIRST COMBINATION – Document A plus one other document                                               Please
                                                                                                               
 A – A document giving the person’s permanent National Insurance Number and name. This could be a
 P45; P60; National Insurance Card or letter from a Government Agency. Please note that a temporary
 National Insurance Number (starting TN) is NOT acceptable.
 Plus one document from:
 B – A full birth certificate issued in the UK, which includes the names of the holder’s parents, OR
 C – A birth certificate issued in the Channel Islands, the Isle of Man or Ireland; OR
 D – A certificate of registration or naturalisation stating that the holder is a British citizen; OR
 E – A letter issued by the Home Office to the holder which indicates that the person named in it can stay
 indefinitely in the UK, or has no time limit on their stay; OR
 F – An Immigration Status Document issued by the Home Office to the holder with an endorsement
 indicating that the person named in it can stay indefinitely in the UK, or has no time limit on their stay;
 OR
 G – A letter issued by the Home Office to the holder which indicates that the person named in it can stay
 in the UK and this allows them to teach; OR
 H – An Immigration Status Document issued by the Home Office to the holder with an endorsement
 indicating that the person named in it can stay in the UK, and this allows them to teach.

 LIST 2 – SECOND COMBINATION – Document A plus one other document                                              Please
                                                                                                               
 A – A work permit or other approval to take employment that has been issued by Work Permits UK.
 Plus one document from:
 B – A passport or other travel document endorsed to show that the holder is able to stay in the UK and
 can take the work permit employment in question; OR
 C – A letter issued by the Home Office to the holder confirming that the person named is able to stay in
 the UK and can take the work permit employment in question.

If you do not satisfy this section then you will not be selected for the programme.
Further guidance may be found at www.ind.homeoffice.gov.uk




MandCGTP Form 020/06/2012                                                                                        3/15
Part C – Previous QTS
The information that is provided in this section is essential to establishing the candidate’s eligibility for GTP
programmes. Please ensure that this section is completed fully and accurately. All information provided will be
treated as confidential
The Consortium will not accept applications from candidates who have previously failed QTS assessment.
The Consortium may however consider those who have withdrawn from a QTS programme due to exceptional
circumstances



Have you previously failed a QTS course?                                      YES                  NO


Have you previously withdrawn from a QTS course?                              YES                  NO

If you ticked YES but consider exceptional circumstances forced your withdrawal please use the space below to
state the reason ensuring that you attach a supporting statement from your Higher Education Institution
and any other supporting evidence e.g. medical certificates:




Comments: QTS Exceptional Circumstances




Assessment: (do not complete)
                                                 No QTS/Exceptional Circumstances acceptable




MandCGTP Form 020/06/2012                                                                                    4/15
Part D – Teaching Programme

A2.2 All candidates recommended for the award of QTS (Teachers' Standards) are assessed as
meeting the standards across two or more consecutive age ranges.


Please select the two age ranges of your programme:


                             SCHOOL YEARS                         SECONDARY SUBJECT                                         SELECT
  AGE RANGE
                                                                  State ONE subject only (see guidance)                     ()

                             Foundation Stage                     N/A
    Ages 3-5 +
     Ages 5-7                School years 1-2

                             School years 1-2                     N/A
    Ages 5-7 +
     Ages 7-9                School years 3-4

                             School years 3-4                     N/A
    Ages 7-9 +
    Ages 9-11                School years 5-6

  Ages 11-14 +               School years 7-9
   Ages 14-16                School years 10-11

  Ages 14-16 +               School years 10-11
   Ages 16-19                School years 12-13


It is required that all trainees will enhance their programme with experience in the age ranges above and below their teaching range.



A1.4 That all candidates have passed the professional skills tests prior to entry.

Please supply your Teacher Reference Number
(TRN)

Please supply the dates of passing the professional skills tests:

Literacy


Numeracy




MandCGTP Form 020/06/2012                                                                                                               5/15
Part E – Your Education and Qualifications
E1 – GCSE or equivalent qualifications
Please give details of GCSE or equivalent qualifications and when they were obtained. You must have attained the
standard required for GCSE grade C in English and Mathematics before you start training. Candidates who will
be teaching the primary age range must also have attained the standard required for GCSE grade C in Science.
This section must be completed in full by all applicants.
                                                                                        Date of award or
                   Qualification and awarding body or details of                          assessment
  Subject                                                              Grade
                           alternative test or assessment
                                                                                   M      M     /     Y     Y

Mathematics                                                                                     /

English                                                                                         /

Science                                                                                         /
Copies of certificates and evidence of equivalency must be provided with this application. Original certificates
will be required for interview. It is the candidate’s responsibility to provide evidence of qualifications and/or
equivalence.
Assessment: (do not complete)

                                                                                 Maths Grade C (All)

                                                                                English Grade C (All)

                                                                           Science Grade C (Primary)


E2 – Other GCSE O-level and A-level qualifications or equivalent
                    Qualification/Awarding body/Other forms of                           Date of award
  Subject                                                              Grade
                                    assessment
                                                                                   M      M     /     Y     Y
                                                                                                /
                                                                                                /
                                                                                                /
                                                                                                /
                                                                                                /
                                                                                                /
                                                                                                /
                                                                                                /
                                                                                                /
                                                                                                /
                                                                                                /
Copies of certificates and evidence of equivalency must be provided with this application. Original certificates
will be required for interview. It is the candidate’s responsibility to provide evidence of qualifications and/or
equivalence.




MandCGTP Form 020/06/2012                                                                                  6/15
E3 – Primary Candidates Only – Subject Qualifications and Knowledge

When you are assessed for QTS, if you are wishing to teach EYFS, Key Stages 1 or 2 you must demonstrate that you
have sufficient understanding of a range of work across the following subjects: Literacy, Numeracy, Science, History
or Geography, Physical Education, ICT, Art and Design or Design and Technology, Performing Arts, Religious
Education and Modern Foreign Languages. You should be able to teach these subjects in the age range for which you
are trained with advice from an experienced colleague where necessary. It will be an advantage for candidates
planning to teach EYFS/KS1/2 to cover all National Curriculum subjects, and EYFS if applicable. You should detail
your depth of knowledge in each of these areas at the time of application. Please read the guidance.


Demonstrate how your subject knowledge and experience matches the National Curriculum requirements of the phases of your application




Assessment: (do not complete)
(Primary Candidates Only)                                                                                            Literacy
                                                                                                                  Numeracy
                                                                                                                      Science
                                                                                                     History / Geography
                                                                                                      Physical Education
                                                                               Art & Design / Design & Technology
                                                                                                          Performing Arts
                                                                                                     Religious Education
                                                                                                      Modern Languages
                                                                                                                        EYFS




MandCGTP Form 020/06/2012                                                                                                              7/15
E3 – Secondary Candidates Only

QTS places a strong emphasis in the development of your Subject Knowledge for Teaching.
Standard 3 states: "A teacher must demonstrate good subject and curriculum knowledge."
Assessment Only Requirement A1.2 states: That all candidates hold a first degree of a United Kingdom higher
education institution or equivalent qualification.
Footnote: A first degree comprises 300 HE credit points of which 60 must be at a level 6 of the national qualifications
framework (NQF). Applicants with a foundation degree will need to supplement this qualification with at least 60
credits at level 6 (HE level 3) in order to attain an equivalent qualification.
Relating the QTS Standards to the Requirements and demands of the programme for Secondary trainees means that
a Secondary Trainee must be able to demonstrate degree-level subject knowledge in the subject that they are training
to teach, and that they continue to develop this subject knowledge throughout their career.
Please complete the following questions about your Subject Knowledge.
(Please note: If you do not have a clear relationship between your degree and the subject of your application, please
provide additional information (see guidance).)
Demonstrate how your degree matches the National Curriculum requirements of the subject of your application:




Demonstrate how you have developed your subject knowledge since completing your degree:




Assessment: (do not complete)
                                                             Clear relevance of degree with enhancement of SK
(Secondary Candidates Only)




MandCGTP Form 020/06/2012                                                                                        8/15
E4 – Higher Education
Candidates must have a UK first degree or equivalent. If you are waiting for degree results, please ask the higher
education institution to confirm in writing that a degree will be awarded and if possible to indicate the classification. If
you do not have a UK degree, it is your responsibility to provide evidence of equivalence.
If you have a Second or Higher degree, please copy this page and provide details of all qualifications.

Institution of Study

Degree awarding body (if
different)

Country of study

Title of course


Main subject                                                                       Percentage of Course                      %

Subsidiary                                                                         Percentage of Course                      %
subjects/Modules
                                                                                   Percentage of Course                      %
                                                                                   Percentage of Course                      %
                                                                                   Percentage of Course                      %
                                                                                   Percentage of Course                      %




Qualification obtained


                                    First Class honours                   Upper second               Lower second
Degree Class
                                                    Third                          Pass                       Ordinary

                            M   M     /   Y   Y             M   M     /    Y   Y                          M   M    /     Y   Y
     Date of study from                              to                             Date of award
                                      /                               /                                            /


For qualifications other than a UK degree, give evidence below that the qualification is equivalent and attach any
relevant supporting statements from UK NARIC. Please note that it is the candidate’s responsibility to ensure that
this evidence is available at the time of application.




Copies of certificates and evidence of equivalency must be provided with this application. Original
certificates will be required for interview.




MandCGTP Form 020/06/2012                                                                                                    9/15
Part F – Personal Statement

In no more than 500 words, please write a personal statement in support of your application. Please read the
Guidance before completing this section.




MandCGTP Form 020/06/2012                                                                                      10/15
Part G – Your Experience

G1 – Teaching Experience

Please give details of previous employment as a teacher, qualified or unqualified, paid or voluntary, in the UK or
elsewhere.
Please copy this page and provide details of each school where you have teaching experience.
School/College
Country/LA                                                               Post held
Dates of service                                                         If working part-time,             %
                                                                         percentage of time working
   From                                  To
Please tick the box(es) that best describe the school:
                   Primary                               Independent                             Special
Middle deemed Primary                         City Technology College                   Higher Education
              Secondary                             Specialist School                       City Academy
       Further Education                        Other (please specify)
     Age range of pupils
                                                  Responsible for whole class         Yes              No
                 taught
Subjects taught to
public examination level
Other subjects taught


Details of Experience
(please cover times
responsible for:
Short & medium term
planning; Solo teaching;
working with small groups;
working alongside
experienced teachers;
working with other
professionals;
familiarisation with
schemes of work; subject
work/knowledge
experience; extra
curriculum work; working
with parents; field trips;
etc.)




MandCGTP Form 020/06/2012                                                                                       11/15
G2 – Experience in an Educational Setting


Please give details of previous employment, paid or voluntary, as a teaching or classroom assistant in the UK or
elsewhere.
If you have experience in more than one school, please copy this page and provide details of all experience.
School/College
Country/LA                                                                Post held
Dates of service                                                          If working part-time,                 %
                                                                          percentage of time working
      From                                To
Please tick the box(es) that best describe the school:
                   Primary                                Independent                               Special
Middle deemed Primary                        City Technology College                      Higher Education
               Secondary                             Specialist School                        City Academy
       Further Education                        Other (please specify)
   Age range of pupils in
                                                  Responsible for whole class           Yes                    No
                  class
Details of Experience
(please cover involvement
in:
Short & medium term
planning; Solo teaching;
working with small groups;
working alongside
experienced teachers;
working with other
professionals;
familiarisation with
schemes of work; subject
work/knowledge
experience; extra
curriculum work; working
with parents; field trips;
etc.); non-teaching work in
educational settings
(teaching assistant, LSA,
LM, etc.) with adults,
young people or children




MandCGTP Form 020/06/2012                                                                                           12/15
G3 – Employment History


Please complete the history of your employment since leaving school.
Please identify and explain any gaps.

                                                    Paid or    Full or Part   Dates From -
               Current Post and Employer
                                                   voluntary      Time            To




                                                    Paid or    Full or Part   Dates From -
               Previous posts and activities
                                                   voluntary      Time            To




MandCGTP Form 020/06/2012                                                             13/15
Part H – References
Please provide below the names of two referees who can support your application in terms of your relevant
experience. One of the references should be the Headteacher of your employing school.
                                   First Referee                                Second Referee

Name

Relationship to
Candidate / Job
Title

Address




Postcode

Telephone

Fax

Email




Part I – Employing School

Please note this information should be your current employing school.
The Headteacher and Chair of Governors also need to complete Form089 certifying your employment and their
support for your programme


Name of
employing School
Address




Town or city                                                      Postcode
Contact Person & Title:
Telephone:                     Fax:                               E-mail:


Schools
Unique Reference                          LA
Number




MandCGTP Form 020/06/2012                                                                                   14/15
Part J – Declaration by Candidate

A         The information about my qualifications and experience in this application is true.

          I have enclosed true photocopies of all required documentation and will present all original documents for
B
          inspection if invited to interview.

C         I agree to prepare and present myself for assessment at the agreed time.

          I understand the terms and conditions of my appointment and my preparation for assessment and agree
D
          to abide by them.

E         I have not previously failed a QTS programme.

          I have included details of any QTS programme that I have previously withdrawn from or had to withdraw
F
          from.

G         I do not already have Qualified Teacher Status.

          I agree that the information in this application and any agreed training plan may be made available to
H         Tutors, a TA-approved external assessor or accredited-provider assessor as appropriate to enable them
          to assess me against the Standards for the Award of QTS.
          I agree that the information in this application and any agreed training plan may be made available to the
I
          Teaching Agency and Ofsted to enable them to carry out their quality assurance role in teacher training.

J         I agree to undertake Identity, Criminal Record and Health checks.


Signed:                                                              Date:


Applications can be sent by email to: admin@mandcgtp.org.uk A receipt will be issued
This form must be accompanied by copies of all certificates (Parts E1, E2 & E4), copy evidence of
employment eligibility (Part B), School Certification (Form 089) and the appropriate fee.
Alternatively, your application can be printed and posted with copy documentation and fee to:
Bob Cleverly
A210, Merseyside & Cheshire GTP Consortium
The Heath Business & Technical Park
Runcorn
Cheshire WA7 4QX


Comments




Eligible for Programme




MandCGTP Form 020/06/2012                                                                                        15/15

								
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