Please Write In CAPITAL LETTERS In Black Ink Or Type CONFIDENTIAL

CONFIDENTIAL Please write in Black Ink or Type Additional supportive information relevant to your application would be welcome. APPLICATION FOR A TEACHING APPOINTMENT AS

______

at Fulford School ______EDUCATIONAL SERVICES If you wish to be considered on a job share basis only please indicate by ticking this box.

PERSONAL DETAILS

Surname Forenames

Postal Address Home Address (if different)

Postal Code Postal Code

Email Address Telephone Number Telephone Number Have you taken premature ill health retirement? DfEE Reference Number PRESENT OR MOST RECENT POST (Newly qualified teachers should omit this section)

SCHOOL DETAILS

Name of school Nature of school

(e.g. Primary/Secondary/Comprehensive/selective/ mixed/boys/girls) Age range Number on Roll

LEA (Please name) or Grant Maintained Title of Post

Date of appointment Current Salary Spinal Point (or enclose copy of current Point Score) This information is essential Main Duties PREVIOUS WORK EXPERIENCE

TEACHING EXPERIENCE Please list putting most recent first. Newly Qualified Teachers should give details of teaching practice

School and LEA Details of Post Dates From To

OTHER WORK/EXPERIENCE Please give details putting most recent first, of any other full-time, part-time, voluntary work or unpaid activities.

Employer/Organisation Outline of main Duties/Skills Dates From To QUALIFICATIONS - EDUCATION

Secondary School/College of Further Dates Qualifications: GCSE etc. Number; Dates Education ‘A’ /BTEC etc. Please give subject details and grades.

College of Higher Education/University Dates Degree or Certificate Degree. Please Dates state classification

Other qualification Dates Dates (full details and dates)

COURSES Please give details of recent significant in-service training courses etc. attended . (Newly Qualified Teachers are invited to outline the key elements of their courses and dissertation work). These should be listed on a separate sheet indicating the organising body, dates, and nature/title of the course. REFERENCES

Please supply names and addresses of persons willing to supply references: one of the named referees should be your current or most recent employer from whom a reference will normally be obtained. Name: Name: Address Address

Job Title Job Title Telephone Number Telephone Nnumber: Fax number: Fax Number Email Address Email Address

In accordance with the Council’s Equality in Employment Statement, disabled candidates will be treated fairly and on the basis of merit only. In order for the Council to fulfil its duties under the Disability Discrimination Act 1995, aids and adaptations will be provided if necessary. Please answer the following:-

Do you consider yourself to have a disability: YES NO

Would the provision of any aids or modifications assist you in carrying out the duties of the post?

Is there any provision you require if invited for interview?

The applicant should state if to his/her knowledge he/she is related to any member of, or to the holder of any senior office under the City of York Council or the Education Committee, or to any Governors of this school.

Canvassing of any member of the Governing Body or the City of York Council could lead to disqualification of the candidate concerned. Have you ever been dismissed from a post because of misconduct or resigned whilst disciplinary action has been taken against you?

YES NO

If so, and you consider it relevant to the post for which you are applying, please give further details on a separate sheet of paper. Please note that appointment to this post will be subject to medical clearance. It will also be subject to the Authority’s procedures for disclosure of criminal background of those with access to children. Under these procedures the successful candidate will be required to furnish a statement of any previous convictions, which will be checked by the Police.

Date on which applicant could take up appointment if appointed:

I confirm that the information I have provided is true and accurate.

Signature: Date: