Alperton Community School

Upper-schoolsite:StanleyAvenue

Wembley,MiddlesexHA04JE

Lower-schoolsite: EalingRoad

Wembley,MiddlesexHA04PW

Tel: 020 8902 2038Fax:020 89001236

Email:

Headteacher:Mr GerardMcKennaBSc(Hons)NPQH

APPLICATIONFORA SUPPORT STAFFAPPOINTMENT

Title ofPost:

Closing date for completed form:

Where did you see this vacancy advertised?

Please returnformto:

When could you take up duties ifappointed:

Please read carefully allinstructions before completingthisform.

We are unabletoacknowledge applications.If we have not contactedyouwithin14 daysof the closingdateyoucanassume thatyour applicationhasbeenunsuccessful.

Part A–PersonalDetails
Title
FirstName
Surname
Address
Postcode
Address for correspondence (ifdifferent fromabove)
Postcode
Telephone / Day / Evening / Mobile
Email
If applicable, do you need a work permit to work in this country?Yes No 
Ifyou have a work permit,please state ifthere are any limitations /conditions /expiry date on the work
permit.
National Insurance No.
Please indicate ifyou have a disability you wantthe school to take into account.
Yes No
Please outline whatassistance (ifany) you need during the recruitmentand selection process e.g. a
signer.
Part B –Educationandtraining –1.SecondaryEducation
Details ofsecondary /furthereducation. Please listall schools, colleges,etc. which you have attended.
Name ofestablishment
(school, college, etc.) / Qualification gained & Subject / Grade / Dates
From / To

Please continue on a separate sheetifnecessary. You will be asked to provide original proofofrelevant

qualifications ifyou are interviewed.

Part B –Educationandtraining –2.Higher Education/ Qualifications
Details ofhigher education/qualifications. Please listall colleges, universitiesetc. which you have
attended.
Name ofestablishment
(school, university, etc.) / Qualification gained & Subject / Grade
/Class / Dates
From / To
Part B –Educationandtraining –3.Other qualifications
Name ofprofessional body / Was membership gained by
examination / Membership
grade / Date
Part B –Educationandtraining –4.RelevantIn-Service Courses
Details ofall relevantin-service courses attended.
Course / Qualifications gained
(ifapplicable) / Dates
Part C– 1.Present or most recent employment
Name and address ofemployer
Postcode
Tel. no. / Fax. No.
Postheld
Date started / Until
Basic Salary
Key roles /achievements
1.
2.
3.
Reason for leaving
Part C–2. Full employment history (most recent first)
Name and full address of employer
(including telephone no.) / Date ofemployment / 1. Position
2. Salary / Reason for leaving
From
DD.MM.YY / To
DD.MM.YY
1.
2.
Tel.
1.
2.
Tel.
1.
2.
Tel.
1.
2.
Tel.
Tel. / 1.
2.
1.
2.
Tel.

Please continue on a separate sheetifnecessary.

Have you ever been dismissed by an employer?Yes No 

Details

Part D–Experience / Relevant Skills/ FurtherInformation

Use this section to show how you meetall ofthe shortlisting criteria for the job as setoutinthe person specification, drawing on all aspects ofyour education, training and experience,including paid or unpaid employment, voluntary work, and home responsibilities.

Shortlisting will be conducted only on the basis ofwritten applications. Itis therefore essential thatall applicants, both internal and external, should complete this section ofthe application form.

Please continue on a separate sheetifnecessary.

Part E – Verificationof Employment
Please give names and addresses oftwo people who can provide employmentreferences. One referee
should normally be your currentemployer.
Referee 1 / Referee 2
Name / Name
Position held / Position held
Address
Postcode / Address
Postcode
Tel. No. / Tel. No.
Fax. No. / Fax. No.
Email / Email
Please tick this box ifyou do notwish the school to approach your presentemployer until, and if, a
firmoffer ofemploymenthas been made. The school normally takes up references ifyou have been shortlisted. Please note thatwe reserve the righttoapproach any ofyour previous employers for references ifnecessary.

CriminalConvictions

By law, spentconvictionsmustbe disclosed. Wouldyou please give details ofany criminal convictions

(notincluding minor traffic offences). Ifyou have no convictions please write ‘NONE’.

Declaration

Ihereby declare thatIhave understood and complied with the requirements laid down in the previous paragraph and Iagree that the information given on this form may be used forregistered purposes under the DataProtection Act,1984.I have also understood and complied with theprovisions concerning the disclosure or criminal convictions.

Failure to disclose information or providing deliberate false information tosupportyour application or

canvassing, directly or indirectly, anyone likely to be involved in the appointmentprocess will disqualify
you fromappointment or if appointed will render youliable to dismissal withoutnotice.
Name
Signature / Date

Upper-schoolsite:StanleyAvenue

Wembley,MiddlesexHA04JE

Lower-schoolsite: EalingRoad

Wembley,MiddlesexHA04PW

Tel: 020 8902 2038Fax:020 89001236

Email:

Headteacher:Mr GerardMcKennaBsc(Hons)NPQH

ADDITIONAL DECLARATION OFINFORMATION

CONFIDENTIAL

Tobecompletedbyall applicants.Pleasecompleteintypeor blackink.

PersonalDetails

Acheckon the possible existence and contentofacriminal record will normallybe requested from the Criminal RecordsBureau after a person hasbeen selected for appointmenttothispost. Refusal toagree to a checkbeing made could disqualify you frombeing considered for the appointment.

You are thereforeasked tosign the statementonthisdocument toconfirm your agreement, ifyou are selected for the appointment, to acheckbeing made on any criminal recordapplicable to you.

Under the Rehabilitation ofOffendersAct1974, youhave the rightnottodisclose detailsof‘spent’ convictions. However,because we are a school and you will be working in anenvironmentwith children and young people we are allowed to askabout these offences. TheRehabilitation ofOffendersAct1974 (Exceptions) Order 1975 (asamended) setsoutdetailsofall jobsto which thisappliesand the job you have applied for isincluded in thatlist.

Please give detailsof ALLconvictions,cautions, bindovers,reprimands,orwarnings(whether spent or not).

CriminalRecordsBureau

TheCriminal RecordsBureau isan executive agencyof the Home Office andhelpsemployers check recordswhich werepreviouslyheld bythe police, the DepartmentofHealth and the Department for Children, Schoolsand Families. Differentlevelsof disclosure can be provided, according to the type of workapplied for.

Thejob for which you have applied will necessitate an Enhanced Disclosure. These are for positions with a greater degree ofcontactwith children or certain vulnerable adults, likesocial workersand teachers, for example. They contain all the information given on a StandardDisclosureplusrelevant non-conviction informationheld atlocal levels.

Have you ever been subject to any sortofinvestigation byan employer? YesNo

Ifyou have answered ‘yes’ tothisquestion, please give detailson a separate sheet.

Please supplydetailsofactivitiesinvolving contactwith children and vulnerable adultsoutside the work

environment(eg. sports coach, scoutleader etc.). Pleasecontinue on a separate sheetifnecessary.

Declaration
Iagree, ifIamselected for thisappointment,to an application being made to the Criminal Records
Bureau for anEnhanced Disclosure concerning myself.
Ialso consent to ACScarrying outother appropriate checks with the Criminal Records Bureau ifitso wishes.
Name (please print)
Signature / Date