Thomas Telford School s1

The White Hills Park Federation Trust (comprising Alderman White School, The Bramcote School and Bramcote College)

Confidential Application Form Please complete in BLOCK CAPITALS

Post Title: Closing Date:

1. Personal Details

Title: Mr Mrs Ms Miss Other

First Name(s):

Surname/Last Name: Address:

Post Code: National Insurance N°:

Tel N° (Home): Tel N° (Work):

Tel N° (Mobile): Email:

DCSF N°: GTC Registration N°:

Are you in receipt of an Occupational Pension? Yes No

2. Educational/Technical/Professional Qualifications

Subjects/Qualifications Where attained Year From Year to Grade Course/INSET Date

4. Details of Teacher Training

If qualified since 1999, please give date when Newly Qualified Teacher status awarded:

For newly qualified teachers only – 1st Review 2nd Review 3rd Review please confirm current status of induction period including dates/outcomes of reviews Primary  Secondary  Further  Age range for which Main teaching subject: Subsidiary subjects: (Please select as appropriate) trained:

5. Current Employment

Employer Salary/ Job Held From To Reason for Leaving (Name & Full Address) Grade

Brief description of duties: 6. Previous Employment History

Please give details of ALL jobs held including part-time and unpaid work.

Employer Salary/ Job Held From To Reason for Leaving (Name) Grade

7. Periods of Unremunerated Activity Have you had any periods of unremunerated activity after the age of 18 years (e.g. raising family, unpaid voluntary work)? Yes  No  If yes, please give details: Dates From To 8. Relevant Knowledge, Experience & Skills

You may wish to include additional information in support of your application. This should be brief, but in any case, no more than three sides of A4 paper. This additional information should include some indication of why you are interested in the post and what experience, interests and skills you can offer in relation to the job description/person specification. NOTE: Your response to this section is extremely important and will be the basis of the shortlisting panel’s decision to invite you for interview. 9. Health/Medical Details

Successful applicants will be required to complete a confidential medical questionnaire and may be required to undergo a medical examination. Details of your sickness absence will also be requested from your employment referee.

10. References

Please provide the name, address and status of two persons who can support your application and who have agreed to their names being used. Friends and relatives are NOT acceptable referees. Unless there are good reasons to the contrary, one of the referees should represent your present employer. If you have not previously been employed, Headteachers, College Lecturers or other persons who are able to comment authoritatively on your educational background and/or personal qualities, are acceptable as referees. Where references are taken up on shortlisted candidates prior to interview, an opportunity will be given to discuss the content of references with the interviewing panel. ALL APPOINTMENTS ARE SUBJECT TO SATISFACTORY REFERENCES.

Do you give consent to us contacting your present employer prior to interview? Yes  No 

If No, please give reasons.

Reference 1 Name: Position: Address:

Post Code:

Telephone N°: Email:

Reference 2 Name: Position: Address:

Post Code:

Telephone N°: Email:

I declare that the information I have given on this form is correct

Signed Date Applicants can normally expect to be invited for an interview within three weeks of the closing date. Otherwise they may assume that, on this occasion, their application has been unsuccessful. 11. Declaration of Criminal Offences

The job for which you are applying involves substantial opportunity for access to children. It is therefore exempt from the Rehabilitation of Offenders Act 1974. You are therefore required to declare any convictions or cautions you may be, even if they would otherwise be regarded as “spent” under this Act. The information you give will be treated in confidence and will only be taken into account in relation to an application where the exemption applies. As the occupant of the post will have substantial access to children, an enhanced disclosure request will be made of the Disclosure and Barring Service (DBS) to ascertain whether their records reveal any criminal convictions (including spent ones) relating to the successful applicant. All information given will be treated in the strictest confidence and will be used for this job application only. The disclosure of a criminal record will not debar you from appointment unless the selection panel considers that the conviction renders you unsuitable for appointment. In making this decision the panel will consider the nature of the offence, how long ago and what age you were when it was committed and any other factors which may be relevant.

Failure to declare a conviction may, however disqualify you from appointment, or result in summary dismissal if the discrepancy comes to light.

Have you ever been convicted of a criminal offence? Yes  No  Have you ever been cautioned for a criminal charge? Yes  No  Are you, at present, subject of a criminal charge? Yes  No 

If YES to any of the above questions, please give brief details including dates:

Details of Offence(s) Place & Date of Judgement(s) Sentence(s)

The White Hills Park Federation Trust is committed to safeguarding and promoting the welfare of children, young people and vulnerable adults and expects all staff and volunteers to share this commitment. Successful applicants will receive The White Hills Park Federation Trust’s Safeguarding Policy that outlines the duties and responsibilities of the employer and employees.

12. General

You are required to declare below any relationship with, or to, a member of The White Hills Park Federation Trust. Please state name and position:

Have you ever been the subject of formal disciplinary proceedings? Yes  No 

If Yes, please give details including dates below: Equal Opportunities Monitoring

To help us check that we are employing people fairly, please mark the appropriate sections below Please note that the information provided in this section will not be passed to the shortlisting panel, and will have no bearing on the appointment decision Please complete in BLOCK CAPITALS

Full Name (including Title):

Date of Birth:

Age – please tick as appropriate 16-18 19-35 36-49 50-59 60-65 Over 65

Ethnic Origin Do you consider your ethnic origin to be: White Mixed Black Asian British White & Black African Black British Asian British Irish White & Asian Caribbean Indian Any other white background White & Black Caribbean African Pakistani Any other mixed background Any other black background Bangladeshi Any other Asian background

Any other ethnic group (please specify) Disability Discrimination Act 2005 The information disclosed here will only be used to enable a fair decision to be made and will not be used to discount applicants. Do you consider yourself to have a disability? Yes No If yes, please state nature of disability:

The Disability Discrimination Act defines disability as: The Disability Discrimination Act 2005 defines disability as ‘a physical or mental impairment which has a substantial and long-term adverse effect on the ability to carry out normal day-to-day activities’ and covers people with cancer, HIV and MS from the date of diagnosis. The Act requires an employer to make ‘Reasonable Adjustments’ to working conditions in order to enable disabled applicants to have equal access to employment opportunities.

Where did you see or hear of this job?

Declaration

I consent to the collection, storage and use of my details outlined above. I understand that these details will not be used as part of the selection process. I understand that any use of these details will only involve producing anonymous statistics to monitor the effectiveness of The White Hills Park Federation Trust’s Equal Opportunities Policy.

Signed: Date: ______Please return completed Application and Monitoring Forms to: Recruitment Bramcote College Moor Lane, Bramcote, Nottingham, NG9 3GA Email: [email protected]