Amesbury School

Application for Teacher

  1. Personal Details

Miss  Mrs  Ms  Mr  Other Please specify:
Surname/Family Name / First Names
Preferred First Name: / Gender: Male  Female 
Postal Address
Home phone / Work phone / Mobile
Email
Teacher Registration Number:
Expiry Date:
Are you a NZ Citizen? Yes  No 
If not, do you havepermanent resident status? Yes  No 
OR, a current work permit? Yes  No 
  1. Relevant Qualifications

Educational
Others
  1. Employment History

Present or Most Recent Appointment

Position
Employer
Period of Employment

Other Relevant Employment History

Position
Employer
Period of Employment
Position
Employer
Period of Employment
Position
Employer
Period of Employment
Position
Employer
Period of Employment
Position
Employer
Period of Employment
  1. Referees

Please name three referees. Those listed below may be contacted during the appointment process.

  1. Name

Relationship
Telephone
Email
Address
  1. Name

Relationship
Telephone
Email
Address
  1. Name

Relationship
Telephone
Email
Address
  1. Authority To Approach Other Referees

I authorise the appointment committee to make enquiries of any present and past employers (further to any listed as referees), colleagues of any other persons, who may assist in establishing my suitability for this position. I understand that the panel will seek my approval for each specific contact and that my approval must be given before the Panel makes such contact. Yes  No 
  1. Convictions Against the Law

Have you ever had a criminal conviction Yes  No 
If “Yes” please detail:
Have you been convicted of a driving offence which resulted in temporary
or permanent loss of licence or imprisonment Yes  No 
If “Yes” please detail:
In addition to the information provided, are there any other factors
that the appointment committee should be aware of in order to assess your suitability
for appointment and ability to do the job? Yes  No 
If “Yes” please elaborate:
  1. DECLARATION

I certify that the information given in this application is true and correct. I understand that if I have supplied incorrect or misleading information, or have omitted any important information, I may be disqualified from appointment, or if appointed, may be liable to be dismissed. I confirm in terms of the Privacy Act 1993 that I have authorised access to referees.

If shortlisted, I will provide my passport and driver’s licence –to be sighted and a copy kept on record.

Applicant's signature
Date

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Amesbury School: Scale A teacher