Applicants may e-mail their completed application form to:

Shortlisted candidates will be asked to sign their e-mailed application form when they attend for interview.

/ PARKSTONE GRAMMAR SCHOOL
Sopers Lane Poole Dorset BH17 7EP
Tel: 01202 605605 Fax: 01202 605606
Headteacher: Tracy Harris
Head of Computing
PERSONAL DETAILS
Surname: / Forename(s):
Address: / Title:
Tel No (Home):
Tel No (Work):
Tel No (Mobile):
Post Code: / E-mail:
Current Driving License: Yes / No / DfE No: Date of QTS:
How did you hear of our vacancy?
EDUCATION (post age 16)
Institution(s) Attended / Dates / Qualifications Gained
Please include any higher degrees in this section
PROFESSIONAL TRAINING (Please indicate what INSET you have attended in the last three years)
Course / Date
MEMBERSHIP OF PROFESSIONAL BODIES
Name of Body
PREVIOUS EMPLOYMENT (in chronological order beginning with the first) full or part-time
Nature of
Appointment / FT
or
PT / School/Establishment
(state age range and type of school) / Name of LEA or
other employer / Sex and no. of pupils on roll / Age range
taught by you / Dates of
Employment
CURRENT EMPLOYMENT
Present Salary: ______Scale Pt: ______TLR Allowance: ______
Nature of
Appointment / FT
or
PT / School/Establishment
(state age range and type of school) / Name of LEA or
other employer / Sex and no. of pupils on roll / Age range
taught by you / Date of Commence-ment
INTERESTS (e.g. hobbies, sports, voluntary work)
SUPPORTING STATEMENT
Please use this section to show how your skills, experience and training would enable you to meet the requirements of this post.
(If additional space is required please continue on a separate sheet)
REFEREES
Please give the names, addresses and occupations of two referees, one of whom should be your present or last employer. References will be called for at the time of shortlisting, as required by the ‘Department for Education –Keeping Children Safe in Education’ document, part 3.
Name: / Name:
Occupation: / Occupation:
Address: / Address:
Post Code: / Post Code:
Tel No: / Tel No:
Fax No: / Fax No:
E-mail: / E-mail:
OTHER DECLARATIONS (*Please delete as appropriate)
IPosts with substantial access to children are exempt from the Rehabilitation of Offenders Act (as amended) - see below. Applicants are required to disclose all convictions including those that are “spent”.
This post is exempt from the provisions of section 4 (2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. Owing to the nature of the work, you are advised that, if offered the post for which you are now making application, the offer will be subject to the school being satisfied as to your suitability following a check on any record of convictions, bindovers or cautions held by the Police. Upfront disclosure of a criminal record may not debar you from appointment as we shall consider the nature of the offence.
If you are offered the post you will be asked to complete documentation showing whether you have had any court convictions/bindovers/cautions. Applicants should therefore be prepared to disclose all convictions, bindovers, or cautions, no matter how long ago they happened. Completion of this documentation gives consent to the disclosure by the Police of any convictions/bindovers/cautions to the employer. No disclosure will be sought without your consent but your employment will not be further considered without it. Your confirmation of attendance for interview will indicate acceptance that if offered the post you will complete the aforementioned paperwork and would be willing to discuss any such offences at interview.
You should also be aware that the letter addressed to referees named in your application will advise them that under the Order they are at liberty to disclose any convictions/bindovers/ cautions which they consider relevant to your suitability for employment.
If the declaration provided does not accord with information held by the Police, you will have an opportunity to discuss the discrepancy with the appropriate member of the School before any decision about the relevance to the appointment is reached.
Do you have any convictions, cautions, reprimands or final warnings that are not ‘protected’ as
defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in
2013)?
Yes / No*
2 Are you related to any member of the governing body or school staff? Yes / No*
If yes, please give details ...... ………...... …………...…....
(Any canvassing direct or indirect will disqualify)
3To the best of my knowledge and belief, the information on this application form is correct.
Signed ...... ………...... Date ...... …....………….……....

EQUAL OPPORTUNITIES MONITORING INFORMATION

This sheet will be detached from your application form and not seen by those

who have to decide on the list of applicants to be invited for interview.

The Borough of Poole operates a policy of equal opportunity and fair treatment for employment and advancement. To assist in monitoring the policy, and for this purpose only, you are asked to give details of your age, gender, health, any disability and ethnic origin.

Please tick appropriate box 

Name:……………………………………………………………………………………………...….

Date of Birth:……………………………………………………………... Female  Male 

Post Applied For:…………………………………………………………….. (ParkstoneGrammar School)

HEALTH DECLARATION
Are you in good health? / Yes  / No* 
Do you have good eyesight (with glasses if worn)? / Yes  / No* 
Do you have good hearing (with hearing aid/s if worn)? / Yes  / No* 
Do you take any regular prescribed medication? / Yes*  / No 
Have you ever failed a medical? / Yes*  / No 
* Please give a brief explanation
...... ……………………..
...... ……………………..
Do you consider yourself to have a disability as defined by the Disability Discrimination Act?
(ie ‘A physical or mental impairment which has a substantial and long term adverse effect on a person’s ability to carry out normal day-to-day activities’).
Yes  No 
Is there anything we need to know about your disability in order to offer you a fair selection opportunity?
...... ……………………..
...... ……………………..
Depending on your answers to the above questions, if you are the successful candidate you may be required to undergo a medical examination.

Ethnic Origin (In accordance with the Commission for Racial Equality)

White

British 

Irish 

Any other White background  please state …………………………………………..

Mixed

White & Black Caribbean 

White & Black African

White & Asian

Any other mixed background  please state …………………………………………..

Asian or Asian British

Indian 

Pakistani

Bangladeshi

Any other Asian background  please state …………………………………………..

Black or Black British

Caribbean 

African

Any other Black background  please state …………………………………………..

Chinese or other ethnic group

Chinese 

Other ethnic group please state …………………………………………..