Application Form for Teaching and Head Teacher Appointment

Application Form SHAPE \* MERGEFORMAT Teaching Staff Appointment

Post Applied for

1. Personal Details

Surname Previous Names

Forenames Title

Address

Home Telephone Postcode Number Work Telephone Mobile Telephone Number Number Which numbers are you happy to be contacted on? Home Work Mobile Any

Email Address

2. Eligibility to work in the UK

Do you have permission to work in the UK? Yes ☐ No ☐ National Insurance Number

3. Unique Teacher Number

Post Title/Reference Number

4. Qualified Teacher Status (QTS)

Do you have QTS? Yes ☐ No ☐ If YES, date obtained (DD/MM/YY) If obtained after 07/05/1999, have you completed the Statutory induction period? Yes ☐ No ☐ If NO, please state: a) how long left to complete

b) contact name where part completed

of 12 6. Present Employment

Post Title

Date Appointed (DD/MM/YY) Period of notice

Employers Name

Employer Address

Type of School Age Range

Subject(s) Taught No. on Roll

Brief description of duties and responsibilities

a) Reason for seeking alternative employment or b) Reason for leaving

7. Salary Please give details of current salary and any additional points (please indicate in the appropriate fields below) If you are currently not in employment, please leave this section blank Salary £ Point Full / Part Time

Main Pay Scale 1☐ 2☐ 3☐ 4☐ 5☐ 6☐ Upper Spine 1☐ 2☐ 3☐

Leadership ☐ Points Range to AST ☐ Lead Practitioner ☐

Allowances £ TLR ☐ Retention ☐

Other ☐ (please specify)

of 12 8. Previous Employment – Teaching & Non Teaching Posts (Most recent first)

Employer NOR Dates Grade/ Reason (Please state LA and and Area of (DD/MM/YY) School/College or Group Post Title responsibility Scale for other employer as Size (if applicable) and From To leaving applicable) (if applicable) Salary

Please insert more rows if required, or continue on a separate sheet, and attach securely to the back of the application. 9. Breaks from Employment Please detail any gaps in your employment history, starting with the most recent Dates (DD/MM/YY) Reason Date From Date To

Please insert more rows if required, or continue on a separate sheet and attach securely to the back of the application.

10. Other Relevant Experience Please tell us about any relevant unpaid work or voluntary experience Date From Date To Organisation Role/Experience

of 12 11. University / College / Professional qualifications Including in-service courses leading to recognised qualifications (e.g.HLTA)

From To Qualifications Date Awarded College/University/Institute Classification (MM/YY) (MM/YY) obtained (MM/YY)

12. Education - Secondary/Higher

Dates (MM/YY) Full/Part School/College (please give address) From To Time

13. Qualifications gained

Dates Establishment Qualification Grade From / To

of 12 14. Membership of Relevant Professional Bodies/Institutions/Organisations

Date of Professional Body/Association Membership Level Membership

15. Continuing Professional Development in the last 5 years

Dates Organising Body Subject Award Duration Achieved

16. Relevant Professional Achievements in the last 5 Years (Max 250 words)

of 12 Please add more lines if required.

17. Additional information in support of your application (Please continue on a separate sheet if necessary – no more than two sides of A4)

of 12 18. References Please provide the name of two referees; one should be your current or most recent employer. Where you are not currently working with children, but have done so in the past, one referee must be from the employer by whom you were most recently employed in work with children. If you are a school or college leaver the referee should be your teacher/lecturer. References will not be accepted from relatives or people writing solely in the capacity of friends. As part of our commitment to safeguarding children and safer recruitment, references will be requested for short-listed candidates prior to interview. If you have any strong objections to either reference being sought at this stage, please indicate in the space provided below. Please note that no offer of employment can be made without prior receipt of satisfactory references.

Reference 1

Job Title Relationship to Applicant Organisation name

Organisation Address

Contact Number

Reference 2

Job Title Relationship to Applicant

of 12 Organisation name

Organisation Address

Contact Number

19. Driving Licence You are only required to complete this section if a driving licence is an essential requirement of the post Do you hold a full UK driving licence? Yes ☐ No ☐

ES to th e following questions will not necessarily prevent you from being considered for the post. 20. Relationships

Are you related to any employee or Governor of Long Field Academy? Yes ☐ No ☐ If Yes please specify

21. Criminal convictions and Cautions The Rehabilitation of Offenders Act 1974 (exceptions) Order 1975 does not allow employees with access to children and young people under the age of 18 years the right to withhold information regarding previous criminal convictions, as well as cautions, warnings, reprimands and bind-overs, for any offence (not just those involving children e.g. motoring convictions) which for other purposes are ‘spent’ under the provisions of the Act. You should disclose in this section any previous convictions, cautions, warnings, reprimands and bind-overs. Failure to do so could result in dismissal.

1. Do you have any criminal convictions, cautions, warnings, reprimands ☐ ☐ or bind-overs? Yes No

2. Are you on the Independent Safeguarding Authorities (ISA) Barred List of individuals considered to be unsuitable for working with Yes ☐ No ☐ Children? 3. Are you on the Independent Safeguarding Authorities (ISA) Barred List of individuals considered to be unsuitable for working with Yes ☐ No ☐ Vulnerable Adults?

4. Are you the subject to sanctions imposed by the General Teaching ☐ ☐ Council (GTC) or under a Secretary of State Prohibition Order? Yes No

5. Are you aware of any Police investigation of which you are the subject? Yes ☐ No ☐ If you have answered YES to any of the above questions, please give details of offences, penalties, dates and country in which they occurred, or of allegations made against you. Please put this information in a sealed envelope marked ‘Confidential’ with your name and the post number you have applied for, and attach this to your completed application form. If you are emailing your application form to us, please attach this information as a separate document. In addition, as this post is defined under Safeguarding Vulnerable Groups Act 2006 as a ‘regulated activity’ this Academy will require the successful candidate to produce either an appropriate valid enhanced criminal record certificate or apply to the Disclosure and Barring Service for an enhanced check for a Page 8 of 12 regulated activity.

Declaration: I have read and understood the above statement. If I have any convictions or cautions, warnings, reprimands or bind-overs to declare I will supply written details of them, in a separate envelope marked ‘private and confidential’ with this application.

*Signature: Date:

Any information given, either when returning this application form or at interview will be entirely confidential and will be considered only in relation to this application.

*Please note that if this form is submitted electronically, you will be asked to sign a paper copy if invited to interview.

22. Disability / Health Conditions

The Equality Act 2010 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.

Do you consider yourself to be disabled? Yes/No (Please delete as appropriate) Please indicate below if you require any reasonable adjustments, due to a disability or health condition, to enable you to attend an interview, or which you wish us to take into account when considering your application.

23. Applicant Declaration

I confirm that the statements in this application are true, correct and accurate and that I have not omitted any facts which may have any bearing on my application. By signing this form I agree to this Academy using this information to consult any third parties or external organisations for the purposes of confirming and/or clarifying such information.

I understand that this post is subject to satisfactory Disclosure and Barring Service and Occupational Health clearances, and acceptance of any offer is deemed as acceptance to undertake an Enhanced DBS disclosure check and Health Assessment. I understand that if such clearances are unsatisfactory this may result in dismissal without notice.

I understand that if I don’t tell you about any unspent criminal convictions including cautions, reprimands, warnings or that I am under investigation or have pending prosecutions and this is discovered after appointment, I could be dismissed without notice.

I can produce the original documents of my qualifications, prior to any appointment. I understand that any canvassing, directly or indirectly, will be a disqualification.

of 12 I understand I am required to provide documents proving eligibility to work in the UK, prior to any appointment. I am prepared to undergo a medical examination, prior to any appointment.

I give consent for the information provided on this form and in connection with my application to be held on computer and/or other relevant filing systems and be processed and verified in accordance with the Data Protection Act 1998. I understand that if successful this information will become part of my personal record and if unsuccessful the information will be held confidentially and destroyed 12 months from the closing date, in accordance with the Data Protection Act 1998.

*Signature:

Print Name:

Date: (DD/MM/YY)

*Please note that if this form is submitted electronically, you will be asked to sign a paper copy if invited to interview.

EQUALITY MONITORING SECTION

THIS SECTION WILL BE REMOVED BEFORE THE START OF THE SELECTION PROCESS AND WILL NOT BE MADE AVAILABLE TO THE RECRUITMENT PANEL AT ANY STAGE OF THE RECRUITMENT PROCESS

PLEASE DO NOT DETACH FROM YOUR APPLICATION FORM

PLEASE COMPLETE THE DETAILS ON THE NEXT PAGE

of 12 THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK

of 12 Monitoring Section

Post Applied for: It would be really helpful if you could complete this section for us. The Academy is committed to equality of opportunity in employment and service delivery and the information you provide will help us to ensure fair and equal treatment of applicants and employees alike. The details you supply will be stored separately to the information on the rest of the application form and will not be used as a basis for decision-making within the selection process. 1. How would you describe your ethnicity? (a) White or White British (b) Mixed (c) Asian or Asian British ☐ British ☐ White and Black Caribbean ☐ Indian ☐ Irish ☐ White and Black African ☐ Pakistani ☐ Any other White background* ☐ White and Asian ☐ Bangladeshi ☐ Any other Mixed ☐ Any other Asian background* background* *(Please specify below) *(Please specify below) *(Please specify below)

(c) Black or Black British (d) Chinese or other ethnic (e) Gypsy/Traveller ☐ Caribbean group ☐ Irish Traveller ☐ African ☐ Chinese ☐ Romany Gypsy ☐ Any other Black background* ☐ Any other ethnic group* ☐ Any other background

*(Please specify below) *(Please specify below) *(Please specify below)

2. My sex is Male ☐ Female ☐ Prefer not to state ☐ 3. My date of birth is (DD/MM/YY) Age: 4. The Equality Act 2010 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.’ I consider myself to be Disabled ☐ Non-Disabled ☐ Prefer not to state ☐

5. My Religion or Belief is:

Buddhist ☐ Christian (all denominations) ☐ Hindu ☐ Jewish ☐ Muslim ☐

Sikh ☐ None ☐ Prefer not to state ☐ Other please specify:

6. My sexual Orientation is:

Bi-sexual ☐ Gay ☐ Lesbian ☐ Heterosexual ☐ Prefer not to state ☐

Other please specify: 7. Where did you see this vacancy advertised? (Please be specific e.g. Leicester Mercury, School Website)

Surname Forenames