Catholic Schools Office

Diocese of Lismore

PO Box 158 Lismore 2480

Tel: (02) 66220422

Web:

TEACHER REGISTRATION FOR EMPLOYMENT

  1. Position applied for
/ ..PrimarySecondaryBoth
Secondary subject area
  1. Preferred locations
/ ....TweedRichmondClarenceHastings
PERSONAL DETAILS
  1. Title ...MrDrMrsMsMiss
/ Surname / Given name/s
  1. Former name/s (if applicable)

  1. Marital status
/ _MarriedSingleDivorcedWidowedEngaged
  1. Residential address
/ Postcode
Postal address / Postcode
  1. Contact details
/ Home / Work / Mobile
Email
  1. Date of birth

  1. Country of birth
/ Nationality
  1. Present position

  1. Religion
/ Parish
Name of Parish Priest
  1. Have you been offered a position in the diocese?
/ __YesNo / __CasualPart timeTemporaryFull timenone
Name of school
Aboriginal and / or Torres Strait Islander / __YESNO
EDUCATIONDETAILS
13. Secondary
Schools / Years Attended / Certificates obtained
HSC results(e.g. ATAR) (complete if obtained within the last 5 years)
  1. Tertiary (transcripts required)

Institution / Years attended / Award conferred / Date conferred
  1. Special Educationunits studied

  1. Other qualifications
    Include post graduate, in-service, and skills or interests which would assist you as a teacher.
    State any foreign languages you speak.

  1. Religious Education
    Training, experience, involvement, commitment.

  1. Parish, community involvement
    Describe any way you have been involved in activities associated with the parish and/or local community.

EMPLOYMENT RECORDS
  1. Teaching record
    Indicate in order position held, commencing with the current or most recent. (Beginning teachers should list three most recent practice sessions.)

Dates / School / Positions held
classes/subject / Full time, part time or casual / Reason for resignation/leave
From
to
From
to
From
to
From
to
From
to
From
to
From
to
From
to
From
to
Total full years of teaching experience
Statements of Service must be provided. / Primary / Secondary
  1. Other employment outside of teaching
    Please refer to the information sheet “Classification and Recognition of Prior Service”.

Dates / Employer / Description of position / Reason for resignation/leave
From
to
From
to
From
to
  1. You may wish to comment on positions of responsibility you have held.

  1. Professional associations
    List any professional associations of which you are a member. Include teacher unions.

  1. General state of health
    You may be required to undergo a medical examination upon employer’s request.

  1. Referees
    At least three referees must be nominated. One of these should be from your Parish Priest or Minister and one your present employer.

Name / Position / Address / Phone contact
Q1 Have you been convicted of an offence that would bar you from child related work / YES / NO
Q2 Are you currently subject to any criminal proceedings that if proven would bar you from child related work? / YES / NO
Q3 Have you ever been the subject of a serious allegation involving your conduct with a child or young person, such as a sexual offence, sexual misconduct, assault, ill treatment, neglect or psychological harm that resulted in a notification to a statutory authority under the local child protection legislation? / YES / NO
Q4 Have you ever been the subject of an Apprehended Violence Order (AVO) that was
made for the purpose of protecting a child or young person from harm? / YES / NO

If you have answered YES to any of the above please advise details.

I certify that the information on this form is complete and correct in every detail and I understand that deliberate inaccuracies or omissions may result in non-acceptance of this application and/or termination of employment. I confirm that I have read and accept the conditions of employment.

I understand that my application may not be processed by payroll department if my application is incomplete.

Declaration

Signature...... Date......

Please Note

Your application will be recorded but we DO NOT ISSUE an identification or registration number. Should you gain employment you will receive an employee pin number.

If you have received a Working with Children number from CCYP you should make contact with principals at schools of your choice to advise them of your interest in a teaching position and that you have submitted your Registration documents to this office.

Privacy Act – Employment Collection Notice
In applying for a position you will be providing the Catholic Schools Office (CSO) with personal information which will be used to assess your application. If you have not gained employment in the diocese within a two year period– your application will be destroyed.

The CSO will disclose your information to appropriate schools within the Lismore Diocesan system. However it will not be disclosed to any other party without your consent.

You may seek access to your personal information at the CSO. However, there will be occasions when access is denied, for example, when access would have unreasonable impact on the privacy of others.

If you provide us with the personal information of others, such as referees, we encourage you to inform them that you are disclosing that information and why, so that they can access that information if they wish.

NSW Child Protection LegislationApplies and your WWC clearance number must be included with this application

WWC Expiry Date

Office use only:

Verification date: ……../……../……..

Statement of Service from all previous employers - (relating to teaching)

Certified Copies of 100 points identification
:one item must include photo ID e.g passport or D/L
:for name change please include marriage certificate or change of name certificate

FOR EXPERIENCED TEACHERS:
Copies of degrees, diplomas or Academic transcriptsstating that youhavesatisfied all the requirements for the awards you have attained

OR

FOR BEGINNING TEACHERS: up to date transcript and certified copies of two most recent practicums

Religiousqualifications if applicable

Relevant Certificates/ qualification of courses undertaken
NSWBOSTES: Accreditation Level Provisional or Conditional (provide copy of letter)

OR

NSW BOSTES: Accreditation Number

Interstate Applicants

Please provide documented evidence of the date of full registration granted by the interstate teacher accreditation

authority

If applicable: Application for Classification & Recognition of Prior Service (all documents attached relating to this process)

PLEASE POST THIS APPLICATION TO:

CATHOLIC SCHOOLS OFFICE –

TEACHER REGISTRATION

PO BOX 158

LISMORE NSW 2480

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