Title of Post:
When could you take up duties if appointed?
Please read carefully all instructions before completing this form in full. Please use BLOCK CAPITALS and BLACK, ball point pen since it will be necessary to photocopy your application. You may enclose a curriculum vitae for additional information, if you wish, but not as a substitute for filling in all sections of the form.
If you have a disability which prevents you from using this form, you may submit your application in another format – please contact us for more details.
1 / Title /DR
/ MR / MRS / MISS / MS / / /OFFICIAL USE
Surname / /Date application
received
First name(s) / /2 / Home address / POST CODE: /
Short listed
Yes No
Reference requested
Home Telephone no: / /
Yes No
Mobile Telephone no: / /Reference received
Yes No3 / E-mail address: / /
Appointed
4 / National Insurance No: / /Yes No
56 / Do you hold Qualified Teacher Status?
In which year did you gain QTS?
Teacher Reference No.
Main Teaching Subject(s)
What additional subjects can you offer?
Have you successfully completed a Period of Induction?
Date of completion of Induction Year
Are you currently eligible for employment in the UK? /
Yes No
/ Perm TempF/T P/T
Salary Calculation
Point on spineAllowance point(s)
Year: ………………………..
Yes No TRN No: ………………………
Teacher Reference Number…………………………………………………………….
……………………………………………………………….
Yes No
Authority: ………………….. Date: ……………………….
Yes No
If no, please provide details: ………………………………..
(type of visa and expiry date)
……………………………………………………………….....
7 / Please give dates on which you will NOT be available for interview e.g. holidays
8 / Please give details of any Superannuation Scheme to which you belong
9 / a) Please state number
of days you have been absent from work due to sickness in the past 12 months?
b) How many episodes of absence does this represent?
c) Is this your usual
level of sickness?
10 / EMPLOYMENT HISTORY Please give details of all employment since leaving full time education, starting with the most recent.
From
Month/Year / To
Month/
Year / Name and address of Employer / Position
or post / Annual Salary
MPS/USP
+
TLR
(if applicable) / Reason for leaving
11 / OTHER WORK/ACTIVITIES (Paid or Voluntary) Please give details of any other work or activities in which you have been involved.
12 / EDUCATION AND PROFESSIONAL QUALIFICATION (Where applicable please include details of examinations which have been or are about to be taken but results of which are not yet available) If educated outside Europe please note that the School is required to confirm that you have acquired a standard in English and Mathematics which is equivalent to at least grade C at G.C.S.E. Please give details.
Date / Name of School/College/University / Qualification and awarding body / Attainment Level
13 / TECHNICAL OR PROFESSIONAL DEVELOPMENT Please give details of most significant technical or professional development/training attained in the last 3 years, starting with most recent. Please continue on a separate sheet if necessary
Subject/Area of Development
/ Organisational body / Duration / Qualification (if appropriate)
14 / OUTSIDE interests and activities
15 / Please attach a letter of application in which you address the full range of your skills, knowledge, experience and training that contributes to the strength of your application. You are advised to refer to the Job Description and Person Specification.
16 / REFEREES Please supply the names and contact details of two people who we may contact for references. One of these must be your current or most recent Headteacher. If your current/most recent employment does/did not involve work with children, then your second referee should be from your employer with whom you most recently worked with children. Neither referee should be a relative or someone known to you solely as a friend. The School intends to take up references from all shortlisted candidates before interview. The School reserves the right to take up references from any previous employer.
Referee 1
Name
Occupation/status
Address
Tel. No.
Fax. No.
E-mail address / Referee 2
Name
Occupation/status
Address
Tel. No.
Fax. No.
E-mail address
17 / CRIMINAL CONVICTIONS
This post is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 therefore all convictions, cautions and bind overs, including those regarded as ‘spent’ must be declared. If you have any of these and have ticked YES, you must provide details in a sealed envelope, marked confidential, attached to your application form.
Have you ever been convicted/cautioned or bound over for a criminal offence? / Yes No
Has your name been referred to OR included on these lists? / The Protection of Children Act List
The DCSF List 99
The Protection of Vulnerable Adults List
18 / Are you related to, or have a close personal
relationship, with any member of Kingsbury High School Governing Body or staff: / Yes No / If yes, please give name and relationship:
19 / Has any previous employer expressed concerns and/or taken formal action (including suspension from duty) on:
(include any investigations or actions taken by your
Professional body) / Capability/Performance
Yes No
Disciplinary
Yes No / If you have ticked either of these
boxes, please provide details
including dates and action taken, in
a sealed envelope marked
Private & Confidential
20 / It is the School's policy to employ the best qualified personnel and to provide equal opportunity for the advancement of employees including promotion and training and not to discriminate against any person because of their race, colour, national or ethnic origin, sex, sexual orientation, marital or civil partnership status, religion or religious belief, disability or age.
The School is committed to safeguarding and promoting the welfare of children and young people and expects all staff and volunteers to share this commitment.
If your application is successful, the School will retain the information provided in this form (together with any attachments) on your personnel file. If your application is unsuccessful, all documentation relating to your application will normally be confidentially destroyed after six months.
Providing any misleading or false information to support your application or canvassing, directly or indirectly, anyone likely to be involved in the appointment process will disqualify you from appointment or if appointed will render you liable to dismissal without notice.
21 / DECLARATION
1. I declare that all parts of this form have been completed and are accurate to the best of my knowledge.
2. I understand that if I knowingly make any false statements or withhold any relevant information, this may result in subsequent dismissal or the withdrawal of any offer of appointment.
3. I agree that the information given on this form may be used for registered purposes under the Data Protection Act, 1998.
4. I consent to the School processing the information given on this form, including any 'sensitive' information, as may be necessary during the recruitment and selection process. If my application is unsuccessful, all documentation relating to my application will be destroyed.
5. I understand that satisfactory references, Enhanced DBS Disclosure, medical clearance and evidence of the right to work in the UK are required before any final offer of employment can be made.
Signature of applicant / Date
If you submitting this form electronically, you are declaring that the information stated is true and accurate.
You will be asked to sign this form if you are invited to interview
Please return this completed application form to:
Human Resources Department
Kingsbury High School
Princes Avenue
Kingsbury
London NW9 9JR
or email: