Teaching Staff Application Form

Application form for:*

Part A - 1. Applicant's Personal Details

Surname:* Fornames:* Title (Mr, Mrs, Ms etc)* Previous Name(s) (if applicable): N I Number:* Permanent Address:* Temporary Address: Work Telephone:* Home Telephone:* Mobile Number:* Email:* Do you hold QTS?* Teacher Reference Number:*

Are there any restrictions on your being resident or being employed in the UK?*YesNo

2. Education and Training

	Name of Institute and Address	From	To	Examinations passed with grades
Secondary School or College:
University of College:
PGCE Institute attended (if applicable):
Post Graduate Study:
NPQH (if applicable):

3. Inservice Training/Professional Development

Long courses over 3 days attended in the last 3 years

	Title	Organising Body	From	To

Short courses (1-2 days) attended in the last 2 years

	Title	Organising Body	From	To

4. Employment Record (please list current employment first) Please ensure there are no gaps in employment history (if there has been a break for any reason please advise)

	Name and address of employer	If a school Number on roll	Age range of school	Job title and salary	Full/part time	To	From	Reason for leaving

5. Employment other than teaching

	Name of organisation	Job Title	From	To

6. Current Salary

Basic annual salary (please indicate spinal point):* Additions (please give responsibility points, London allowance, etc.):* Total salary:*

7. Professional References - please give the names of two referees who can vouch for your professional work, one of whom should be your present employer.

i) Name:* Position:* Address:*

Please contact me prior to reference being taken up:*YesNo

Telephone number:* Email address (where possible): ii) Name:* Position:* Address:*

Please contact me prior to reference being taken up:*YesNo

Telephone number:* Email address (where possible):

8. Supporting Statement - Your application should be supported by a letter of not more than 2 sides of A4 (12pt), addressing the criteria in the person specification for this post.

9. Leading and Teaching in a Church of England School or Academy - We welcome people of many faiths and beliefs. We do, however, ask that all staff should support the values, ethos and philosophy of a Christian school, in the tradition of the Church of England, and we would expect staff to make a positive contribution to the development of that Christian ethos. We expect our school leaders to demonstrate a clear commitment to the Christian ethos. If you are a practising member of a Christian Church, please give details:

Denomination: Place of Worship: Address: Diocese (if applicable): If possible please give the name of a parish priest or minister from whom a reference may be sought: Address: Telephone number: Please add a brief statement here in support of your application to this Church of England school:

Part B - Confidential Information (This section of the form will be removed before shortlisting.)

1. Gender:* 2. Cultural/ethnic origin:* Any other White background, please write in

B MixedWhite and Black CaribbeanWhite and Black AfricanWhite and Asian

Any other Mixed background, please write in

C Asian, Asian British, Asian English, Asian Scottish, or Asian WelshIndianPakistaniBangladeshi

Any other Asian background, please write in

D Black, Black British, Black English, Black Scottish, or Black WelshCaribbeanAfrican

Any other Black background, please write in

E Chinese, Chinese British, Chinese English, Chinese Scottish, Chinese Welsh, or other ethic groupChinese

Any other background, please write in

4. Criminal History. As this post is classified as having substantial access to children, appointment will be subject to a police check of previous criminal convictions. You are required, before appointment, to disclose any conviction, caution or binding over including ‘spent convictions’ under the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. Non disclosure may lead to termination of Employment. However, disclosure of a criminal background will not necessarily debar you from employment – this will depend on the nature of the offence(s) and when they occurred. Have you ever been convicted of a criminal offence?*YesNo

If yes, give details:

5. Work Status. I understand that under the terms of the Asylum and Immigration Act 1996 should I be short-listed for the post for which I am applying, I will provide for the governing body, as employer, an original document* showing my entitlement to work in this country. *Acceptable documents include your National Insurance card, a birth certificate issued in the UK or Eire, a P45 from your previous employer, a valid passport, or any relevant authorisation allowing you to work in this country.

6. Other information. Are you related to any member of the governing body, LA elected member, senior LA official or officer of LDBS?*YesNo

If yes, please give details: Declaration. To the best of my knowledge the information on this form is correct. I am in possession of certificates, which I claim to hold. I understand that willful falsification or omissions may, if I am appointed, result in my dismissal. You are reminded that any canvassing direct or indirect will disqualify candidates. Successful candidates may be required to produce their birth certificate and original proof of qualifications. I declare that I am not on List 99 or disqualified from working with children. I am not subject to any sanction imposed by the General Teaching Council. I consent to the processing of personal data as defined in the Data Protection Act 1998. Signature:* Date:*