CONFIDENTIAL

Application form for an advertised post as Part-time Pre-Prep Teacher

at Holmwood House School

1.  PERSONAL DETAILS

Surname: / Forenames:
Title: / Date of birth: / DfES Ref No:
Address (home):
(If not resident at this address for 5 years, please provide previous addresses) / Address (work):
Home Telephone: / Mobile Number:
Email address: / Qualified Teacher Status: Yes/No
National Insurance Number:

2  PRESENT TEACHING POST

Present Post (Title): / Date Appointed:
Name of School: / Length of notice required:
Address of School:
Type of School: / Age Range: / Number on Roll:
Single Sex/Mixed: / Grade/Scale: / Current Salary:

3 PROFESSIONAL REFERENCES (one should be your present or most recent employer; relatives and friends should not be used as referees)

Name & Status: / Name & Status:
Address: / Address:
Post Code: / Post Code:
Telephone number: / Telephone number:
Email: / Email:

4 EDUCATION

Secondary Education / Dates
From / To
Qualifications 16+ / Grade / Date
Higher Education / Date
From / To
Subject(s):
Institution:
Degree:
Class:
PGCE:
Further post-graduate study: / Dates
From / To

4  PREVIOUS TEACHING POSTS HELD*

Name of Employer / Type (Ind,
Selective, Comp etc) / (Boys, Girls, Mixed) / Age Range / Nos.
on roll / Title of Post and Scale / Dates
From / To / Reason for leaving

*Please use a continuation sheet if necessary

6  RELEVANT IN-SERVICE TRAINING

Courses attended within the last three years:

Title / Organising Body / Date / Length

7  PROFESSIONAL RESPONSIBILITIES AND ACHIEVEMENTS

8  INTERESTS AND OTHER COMMENTS RELEVANT TO APPLICATION

9. REHABILITATION OF OFFENDERS ACT 1974

The post applied for is exempt from the Rehabilitation of Offenders Act 1974 and therefore all convictions, cautions and bind-overs, including those regarded as ‘spent’, must be declared. Accordingly, the following declarations are required:

·  I am/am not* included on the DBS Barred List;

·  I am/am not* disqualified from work with children, or subject to sanctions imposed by a regulatory body,

·  I have/have not* one or more convictions, cautions, or bind-overs. (If any convictions, cautions or bind-overs are held, details must be provided in a sealed envelope marked ‘Confidential’ and attached to this application)

I understand that if successful in this application, I will be required to obtain a Disclosure at the Enhanced level from the Disclosure and Barring Service.

How did you find out about the vacancy?

Signature: ______Date:

Please return the completed application form to the Headmaster, Holmwood House, Chitts Hill, Lexden,

Colchester, Essex, CO3 9ST or by email at e before the closing date.

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