STRICTLY CONFIDENTIAL Jack Hunt School (Foundation) Ledbury Road, Peterborough, PE3 9PN Tel. 01733 263526 Fax 01733 330364 email firstname.lastname@example.org The Governing Body is committed to safeguarding and promoting the welfare of children and young people and expects all staff and volunteers to share this commitment. APPLICATION FOR TEACHING APPOINTMENT (Please complete this form in BLACK as it may be photocopied) All sections of the application form should be fully completed. POST: 1. PERSONAL INFORMATION TITLE: SURNAME: FIRST NAME (S): PREVIOUS SURNAME E-mail (if applicable) Address: Current Address: Tel Mobile Postcode: No: No: Teacher Reference National No: Insurance No: 2. PRESENT APPOINTMENT (A) If Teaching: Name of Local Education Authority: Name and Address of School: Tel No: Fax No: *Boys/Girls/Mixed Approx No. on Age Date (delete as appropriate) Roll: Range: Appointed: Post Title: (please state any management units and nature of any specific responsibility with reason for awarding) Subject/Age groups taught: Salary Level i.e. M1-M6: Have you been successful in meeting the Threshold Standards and gaining accreditation? YES / NO (delete as appropriate) If so, state your current point on the UPS Scale and the date from which you have been paid at this point: When could you commence duties: (B) If other than Teaching: Nature of Post: Name and Address of Employer: Tel No: Fax No: Date Appointed: Salary: Length of Notice When could you required: commence duties: Training School 3. FULL CHRONOLOGICAL HISTORY Please provide a full history in chronological order since leaving secondary education, including periods of any post-secondary education /training and part-time and voluntary work, as well as full time employment, with start and end dates, explanations for periods not in employment or education/training and reasons for leaving. (continue on a separate sheet if required) Job Title or Name and address of school Number F/T Dates Position or nature of other on Roll or Reason for From To employment (if P/T Leaving Mth Yr Mth Yr school) 1 2 3 4 5 6 7 8 9 4. EDUCATION: SECONDARY/FURTHER Dates F/T or School/Colleges attended (please give addresses) From To P/T Mth Yr Mth Yr Examinations Passed Date Subjects and Grades GCSE, GVNQ, Key Skills or equivalent: A Level, AVCE or equivalent, Other (please specify): 5. EDUCATION - HIGHER (University, College, Polytechnic) - including professional qualifications and in-service courses leading to recognised qualifications. Name and addresses of Dates Full or Date of Qualifications Subjects Age University or College part- examination obtained passed with groups from to and/or University time details of for Education Department standard which obtained trained 6. PROFESSIONAL COURSES ATTENDED AS A TEACHER (Other than those in 5 - over the past 3 years). Subject Organising Body Approximate Duration Date 7. OTHER RELEVANT EXPERIENCE, INTERESTS AND SKILLS 8. REFERENCES Give here details of two persons to whom reference may be made. One must be your present Headteacher or employer. If you are an initial trainee you should give the Headteacher of your placement school. Title: Initial: Surname: Title: Initial: Surname: Job Title: Job Title: Address: Address: Postcode: Postcode: Fax No: Fax No: Tel No: Tel No: E-mail: E-mail: 9. ADDITIONAL INFORMATION Are you, to your knowledge, related to any Member of the Governing Body? YES / NO (delete as appropriate) If so give details on a separate letter. Have you at any time been debarred from teaching post 16 by the DCSF? YES / NO (delete as appropriate) Are you a registered member of the General Teaching Council? YES / NO (delete as appropriate) Do you require a work permit/sponsor licence? YES / NO (delete as appropriate) Did you qualify as a teacher after May 1999? YES / NO (delete as appropriate) If yes – in which school did you complete your induction? Year: Are you a member of a pension scheme? YES / NO (delete as appropriate) Do you hold a current Driving Licence? YES / NO (delete as appropriate) 10. COMPULSORY DECLARATION OF ANY CONVICTIONS, CAUTIONS OR REPRIMANDS, WARNINGS OR BIND-OVERS Jobs in schools are exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974. You must therefore declare any arrests, convictions, cautions or reprimands, warnings or bind-overs which you have ever had and give details of the offences. The fact that you have a criminal record will not necessarily debar you for consideration for this appointment. Do you have any convictions, cautions or reprimands, warnings or bind-overs? YES / NO (delete as appropriate) Have you ever been arrested? YES / NO (delete as appropriate) If the answer is "yes", you must record full details in a separate, sealed envelope marked with your name and 'Confidential: Criminal Record Declaration' and enclose it with your application. In accordance with statutory requirements, an offer of appointment will be subject to satisfactory enhanced CRB clearance. A copy of this notice will be sent to your referees. 11. DATA PROTECTION ACT The information collected on this form will be used in compliance with the Data Protection Act 1998. The information is collected for the purpose of administering the employment and training of employees. The information may be disclosed, as appropriate, to the governors, to Occupational Health, to the General Teaching Council, to the Teachers Pensions Agency, to the Department for Children Schools and Families, to pension, payroll and personnel providers and relevant statutory bodies. You should also note that checks may be made to verify the information provided and may also be used to prevent and/or detect fraud. 12. NOTES a) When completed, this form should be returned in accordance with the instruction in the advertisement for the job or in the applicant’s information pack. b) Canvassing, directly or indirectly an employee or governor will disqualify the application. c) Candidates recommended for appointment will be required to complete a pre-employment medical questionnaire and may be required to undergo a medical examination. 13. DECLARATION I certify that, to the best of my knowledge and belief, all particulars included in Parts 1 and 2 of my application are correct. I understand and accept that providing false information will result in my application being rejected or withdrawal of any offer of employment, or summary dismissal if I am in post, and possible referral to the police. I understand and accept that the information I have provided may be used in accordance with paragraph 11 above, and in particular that checks may be carried out to verify the contents of my application form. 14. LETTER OF APPLICATION Please provide a letter of application if required with the job details. 15. DECLARATION I certify that, to the best of my knowledge and belief, all particulars included in my application are correct. _________________________________ ________________________________ Signature of Candidate Date _________________________________ Print Name Please print this application and sign and date before sending by post or if e-mailing this application, please bring with you a signed copy if invited to interview.
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