Application for Teaching Appointment s5

Goldsmith Primary Academy Goldsmith Road Walsall WS3 1DL Telephone No: 01922 710182 Support Staff Application Form

Windsor Academy Trust is committed to safeguarding and promoting the welfare of children and young people and expects all staff and volunteers to share this commitment. All posts are subject to an Enhanced DBS. Please ensure that you complete the application form in full and use black ink. Please note that providing false information will result in the application being rejected, withdrawal of any offer of employment, or summary dismissal if you are in post, and possible referral to the police. Please note that checks may be carried out to verify the contents of your application form.

Vacancy Job Title

1. PERSONAL DETAILS

Surname Forename(s) Title

Previous Current Surname Address

Post Code

Home Mobile No Telephone No Email Address

National ISA Insurance Registration No No

2. SUPPORTING INFORMATION As part of your application, please include separately: a covering letter of application and any supporting information relevant to the post.

3. PRESENT / LAST EMPLOYMENT Name, address and telephone number of employer

Job title

Date appointed to current post

Current salary

Date left

Date available to commence post

SCo/1mainpersonnel/appforms/wat/support/Goldsmith support staff app form Feb 17 4. FULL CHRONOLOGICAL HISTORY Please provide a full history in date order, most recent first, since leaving secondary education, including periods of any post-secondary education/training, and part-time and voluntary work as well as full time employment. Name and address Job Title or Position and Dates Reason of Employer a description of your role From To for leaving Mth Yr Mth Yr

5. REFEREES Please provide details of two people whom reference may be made. The first referee should normally be your present or most recent employer. If you do not want us to contact your nominated referee before an offer is made please place a X in the box Company Name Address and post code

Job Title Relationship to Applicant Telephone Number and Email address

Company Name Address and post code

Job Title Relationship to Applicant Telephone Number and Email Address

SCo/1mainpersonnel/appforms/wat/support/Goldsmith support staff app form Feb 17 6. SECONDARY EDUCATION AND QUALIFICATIONS (eg GCSE)

Name of School/College From To Qualifications Gained

7. FURTHER OR HIGHER EDUCATION

Name of FE College or University or Dates Full or Part-time Qualifications Obtained Awarding Body From To

8. WORK RELATED TRAINING COURSES

Name of Training Provider Dates Number of days Certificates Obtained From To

SCo/1mainpersonnel/appforms/wat/support/Goldsmith support staff app form Feb 17 9. DECLARATION

9.1 Have you ever been barred or restricted from working with Yes No (If YES give details separately under confidential cover) children or been subject to an investigation? 9.2 Do you have a current full driving licence? Yes No 9.3 Are you subject to any legal restrictions in respect of your Yes No (If YES please provide details separately) employment in the UK? 9.4 Do you require a work permit? Yes No (If YES please provide details separately)

9.5 Date of Birth

9.6 Are you related to or have a close personal relationship with any Yes No (If YES give details separately under confidential cover) student, employee, or governor?

9.7 Where did you hear about the vacancy?

9.8 Are there any special arrangements Yes No (If Yes please specify, (e.g. ground floor venue, sign which we can make for you if you language, interpreter, audiotape etc). are called for an interview and/or work based assessment?

10. CRIMINAL CONVICTIONS OR CAUTIONS Do you have ANY convictions, cautions or reprimands, warnings or bind-over’s? Yes  No  Please see information below before answering this question.

A check as to the existence and content of any relevant criminal record will be requested from the Disclosure and Barring Service after a person has been selected for appointment. Refusal to agree to a check being made could disqualify you from being considered for the appointment. Under the Rehabilitation of Offenders Act 1974, you have the right not to disclose details of “spent” convictions. However, for certain jobs, employers are allowed to ask about these offences. The Rehabilitation of Offenders Act 1974 (Exception Amendment) Order 1986 sets out details of all jobs to which this applies and the job you have applied for is included in this list. The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are “protected” and are not subject to disclosure to employers, and cannot be taken into account. Please give details of any relevant criminal convictions that you may have. The disclosure of a criminal record may not necessarily prevent you from being appointed. The nature of the offence, how long ago it took place, your age at the time and any other relevant factors may be considered when a decision is made. Please note that some convictions are never considered “spent” under the terms of the Act. Please record full details in a separate, sealed envelope marked with your name and “Confidential: Criminal Record declaration” and enclose it with your application.

11. DATA PROTECTION ACT The information collected on this form will be used in compliance with the Data Protection Act 1998. The information is being collected for the purpose of administering the employment and training of employees. The information may be disclosed, as appropriate, to school governors, to Occupational Health, to the Teaching Agency, to the Teachers Pensions Agency, to the Department for Education, to pension, payroll and personnel providers and relevant statutory bodies. You should also note that the information you have provided on this form may 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 with an employee or governor will disqualify the application. c) Appointed candidates will be required to complete a pre-employment medical questionnaire.

13. DECLARATION I certify that, to the best of my knowledge and belief, all particulars included in 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 checks may be carried out to verify the contents of my application form.

______Signature of Candidate ______Date

______Print name

SCo/1mainpersonnel/appforms/wat/support/Goldsmith support staff app form Feb 17