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Ian D Wilkinson

Headteacher

George Stephenson High School

Southgate

Killingworth

Newcastle upon Tyne

NE12 6SA

APPLICATION FOR TEACHING APPOINTMENT

1.Application for post of:______

2.Surname: ______Mr/Mrs/Miss/Ms Forename: ______

3.Date of Birth: ______Nationality: ______

4.Address (if this is a temporary address please also give your usual home address): ______

______

______Length of time at this address (mm/yyyy):______

Previous addresses within last 5 years (continue on a separate sheet if necessary): ______

______

5.Contact Telephone Numbers: Home: ______Mobile: ______

Email: ______

6.Disability: Please identify any special requirements or equipment which may assist you

a. In the recruitment process: ______

b. To enable you to carry out the job: ______

7.Date recognised by the DFE as a qualified teacher: ______DFE Reference No: ______

8.Date registered with the General Teaching Council for England: ______

9.National Insurance Number: ______

10. Please give names of two people who we can ask for a reference. If you are in, or have just completed, full time education one referee should be from your school/college. If you are in employment, one referee must be your present employer. If you are unemployed, one referee should be your last employer.

11. If you are in receipt of a pension payable under the Teachers’ Pensions Regulations following early retirement, please indicate the grounds on which you were retired:

• In the interests of efficiency/redundancy/ill health (delete as appropriate). Date of retirement: ______

12.If you have received a redundancy payment in respect of a previous employment with a local authority, please give details:

Name of Authority: ______Date of redundancy: ______

13.Do you need a work permit to undertake full or part time work in the UK? YES / NO (delete as appropriate)

Which visa do you hold? ______When does this visa expire? ______

14. Are you related to any elected member or employee of the council who may be involved in the recruitment process/

decision making? (To ensure fairness, canvassing or failure to provide this information will result in our not considering your application).

• YES / NO (delete as appropriate)

If yes, please state the name of the relative or partner and the position held:

Name:______Relationship: ______Position: ______

15.Education and Qualifications (please state UK equivalent if known)

16.Teaching Practices (to be completed only by applicants for first appointments)

17.Please give details of any In Service work you have done or courses you have attended during the past 2 years

18.Teaching subjects in order of preference and what level (e.g. Key Stage 3, Key Stage 4, etc)

Age group trained for: ______

19.Present employment or last employment if you are not currently employed

1. Previous Employment (please state most recent first)

21.Details of any Non-Teaching Employment (including any breaks in service)

22. Relevant skills and experiences that you would bring to this job.

Please use this page to show how your experience, skills and abilities are relevant to the post. Remember to include any experience you have gained in community or voluntary work, looking after children, elderly people, etc, as well as previous or present employment. Please continue on a separate sheet of paper if required.

23.THIS SCHOOL IS AN EQUAL OPPORTUNITIES EMPLOYER

North Tyneside Council, to whose policies we adhere, operates a policy of equal opportunities and wishes to ensure that all applicants are considered solely on their merits. Therefore, we need to be able to check that our decisions are not influenced by unfair or unlawful discrimination. To help with this, please complete the questions below. Your answers will be treated confidentially and used only for statistical purposes

24. REHABILITATION OF OFFENDERS ACT 1974

Because of the nature of work for which you are applying, 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 (Exemption) Order 1975. Applicants are therefore not entitled to withhold information about convictions which for other purpose are spent under the provisions of the Act and, in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by the school or Local Authority. Any information given will be completely confidential and will be considered only in relation to any application for positions to which the Order applies. Please give details of any convictions below:

______

______

______

25.PROTECTION OF CHILDREN – DISCLOSURE OF CRIMINAL BACKGROUND. If you are appointed to this post, the LA, on behalf of the school, is required to contact the Police in connection with any previous convictions, bind over orders or cautions you may have. (Refusal to give permission could prevent further consideration of your application).

Do you give your permission for this course of action? YES / NO

26.DECLARATION

I declare that the information in this form is true. I understand that false information may result in my dismissal if I am appointed.

Signature: ______Date: ______

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