Post Applied For

PERSONAL Current Forename(s) Current Surnames) (Block Letters) (Block Letters) Previous Previous Surname(s) Forename(s) N.I. Number DFES Number Telephone numbers Email address (mobile / home / work) Address (inc. postcode)

EDUCATION AND TRAINING (FROM AGE 11) Full or Qualifications Date Establishment Attended Part Awarded (Including Grade / Class) Attended Time (From/To)

Type of Teacher Training (Delete as Further Education / Secondary / Primary appropriate)

Page 1 of 8 TEACHING / EDUCATION MANAGEMENT EXPERIENCE In chronological order starting with your current or most recent appointment. Please provide an explanation for any gaps in employment. Name, Type & Address No. Age Title of Post (Inc. Scale & Full From / To of School/College On Range Allowance)/Reason for or (Dates must be in Roll Taught Leaving Part full e.g. day, Time month, year)

OTHER OCCUPATIONAL EXPERIENCE Details of all occupations including voluntary work since 18th Birthday not recorded elsewhere on this form (excluding vacation work when attending full time education). Please provide details and reasons for any gaps in employment. Name and address of employer / Details of Occupation/Reason for Full From To Voluntary Organisation Leaving or D M Y D M Y Part Time

TRAINING RECORD Please give title / brief summary of training and dates attended in last two years

Page 2 of 8 IMMIGRATION, ASYLUM AND NATIONALITY ACT 2006

Do you have the right to take up employment in the UK, either as a UK National, or Yes / No because you hold a valid work permit?

REFEREES The particulars of two persons with relevant knowledge of your professional competence and to whom references may be sought should be given below. For practicing teachers this must be at Head Teacher or Principal level. One of the referees must be your current (or most recent) employer. If your most recent employment does not involve working with children, you should also give as a referee your most recent employer, who can provide information on your work with children (if you have ever worked with children). Name/Designation/Address Tel. No. E-mail address

Page 3 of 8 IGNORE THIS FORM IF YOU ARE CURRENTLY COMPLETEING A TEACHING COURSE

Record of Your Students’ Achievement (most recent two years if possible) Please complete the following table, for all your examination classes, in as much detail as possible where you have module results for current classes, please include these also. Please use the example given to follow. Course Level Year Shared Students Students Retention A* A B C D E U A-B A-E Success Value Value Set Started Completed % (%) (%) Rate Added Added (Y/N) (Retention Band Measure % x A-E Used %) (e.g. ALPS/ ALIS/ LAT) Example:

English 3 10 Language A2 13/14 N 20 18 90 2 4 5 2 2 0 50 0 90 3 ALPS

Any other comments e.g. Oxbridge etc.

Page 4 of 8 IGNORE THIS FORM IF YOU ARE CURRENTLY COMPLETEING A TEACHING COURSE

Any other comments e.g. Oxbridge etc.

Page 5 of 8 STATEMENT ON SAFEGUARDING Cardinal Newman College is committed to safeguarding and promoting the welfare of children and vulnerable adults and expects all staff, governors and volunteers to share this commitment.

DATA PROTECTION INFORMATION Completed application forms and supplementary information provided by you in support of your application will be retained by the HR Department in a secure place for a period of 6 months, after which time the information will be destroyed. Details of short-listed applicants (application form and supplementary information provided in support of an application, references, interviewer/task notes) will be held for a further 6 months, after which time the information will be destroyed, excepting for persons who subsequently take up employment with the College.

Signature Date

Completed forms should be returned to: HR Department, Cardinal Newman College, Larkhill Road, Preston, PR1 4HD Fax: 01772 204671 e-mail: [email protected]

Page 6 of 8 YOU ARE INVITED TO PROVIDE BELOW A STATEMENT OR LETTER (MAXIMUM 2 SIDES OF A4) IN SUPPORT OF YOUR APPLICATION, OUTLINING HOW YOU MEET THE CRITERIA SPECIFIED IN THE PERSON SPECIFICATION

Page 7 of 8 REHABILITATION OF OFFENDERS ACT 1974

The nature of the post for which you are applying means that it is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. You are not, therefore, entitled to withhold information about cautions or convictions, which for other purposes are ‘spent’ under the provisions of the Act unless covered by the Disclosure and Barring Service filtering rules which specify under what circumstances certain cautions or convictions are classed as ‘spent’. Further information can be found at: https://www.gov.uk/government/publications/filtering-rules-for-criminal-record-check-certificates . Filtering rules do not apply to certain convictions, please refer to https://www.gov.uk/government/publications/dbs- list-of-offences-that-will-never-be-filtered-from-a-criminal-record-check for further information. If you are appointed any failure to disclose cautions or convictions not expressly covered by the filtering rules may result in the offer of appointment being withdrawn or disciplinary action being taken and possibly the police and/or the Disclosure and Barring Service being notified.

If you are successful the information on the form will be considered and, if you have declared any previous criminal convictions, cautions or reprimands, these may be discussed with you prior to a decision being taken on your appointment.

Please be aware that the College has a policy on the recruitment of ex-offenders and that a criminal record will not automatically debar anyone from employment with Cardinal Newman College. You should also be aware that your referee can be informed that they can disclose any conviction they consider relevant.

DECLARATION (Please delete as appropriate)

Have you ever been convicted of any offence in a Court of Law or YES / NO received any bind-overs or cautions from the police (note: any caution or conviction covered by the Disclosure and Barring Service filtering rules need not be disclosed)

Have you ever been included on any Disclosure and Barring/Criminal YES / NO Records Bureau list which disqualified you from working with children or vulnerable adults?

Have you ever been or are currently subject to sanctions imposed by YES / NO a regulatory body e.g. Disclosure and Barring Service, Criminal Records Bureau, National College for Teaching and Leadership, The General Teaching Council or Institute for Learning

If you have answered ‘Yes’ to any of the above questions, please give brief details and dates of any offences below (or if insufficient space continue on the reverse side of this form)

You must sign and date this section of the form in the spaces provided below.

Signature Date

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