Essex and Thames Primary SCITT

Essex and Thames Primary SCITT

Runwell Community Primary School

Canewdon Gardens

Runwell

Wickford

Essex

SS11 7BJ

01268 570 215

Essex and Thames Primary SCITT

Application Form for September 2017 and Self-Funding

Please return the completed form to Emma Nunn, Recruitment Officer, by email ().

Courses

Please tick or type ‘Yes’ in the relevant box

Full time training route 2017-18
Full time salaried 2017-18
Part time training route 2017-18
Full time self-funded 2016-17
Part time self-funded 2016-17
Please indicate if you would be prepared to accept a place on the training route should a salaried place not be available.

Personal Details

First name(s) & Title: / Surname:
Date of birth: / Current age (years and months):
Nationality: / Ethnicity:
Email address: / Address:
Phone number:
Do you have any special needs including dyslexia or medical condition? Please give details.
Do you have any criminal convictions or are you currently on bail or being investigated by the police?

Failure to disclose special needs or criminal convictions may lead to offers of a place being withdrawn.

Qualifications

First degree or equivalent

Name of Institution / Class / Title of course / From / To

Please indicate the predicted grade of your degree if you have not yet graduated.

Subjects taken at A, AS, baccalaureate or equivalent levels

Subject / Year / Level / Grade

GCSE / GCE or equivalent results

Subject / Examining Body / Year / Level / Grade
English Lang
Mathematics
Science

Any other qualifications

Title / Main Subjects / Awarded by / Dates etc

Education

School or College / From (year) / Until (year)

Employment

Details of employment, other than brief spells of casual work.

Date: from - to / Organisation / Role

What other skills, interests, hobbies and talents do you have?

Personal Statement

Please describe your reasons for wanting to become a primary school teacher. You should make reference to your personal strengths, qualities, skills and previous experience working with children.

Please supply the details of 2 referees.

First Referee – should be an educational professional (ideally someone who has observed you working with children)

Name / Post held
Address
Postcode
Telephone no / Relationship to the candidate
Email

Second Referee

Name / Post held
Address
Postcode
Telephone no / Relationship to the candidate
Email

Data Protection Act, 1998: The information that you have supplied will be processed and held on computer. The data may be processed for the purpose of compiling statistics, and passed to the Higher Education Statistical Agency and the Higher Education Funding Council for England. By signing and returning this application form you will be deemed to be giving your consent to the processing of data contained within it and the use of that data for the lawful purposes approved for the institutions to which it is supplied.

Declaration

I confirm that the information I have given on this form is true, complete and accurate and no information requested, or other material information, has been omitted.

Applicant’s signature
(an electronic signature is acceptable) / Date: