TEACHING POSITION APPLICATION FORM
Please post or email to: Application
Tauranga Primary School
31 Fifth Avenue
Tauranga 3110
[email protected]Position applied for: Permanent Scale A 2025 – Middle or Senior School
Applications close Friday 25th October 12pm
PERSONAL DETAILS
Surname
Given names
Preferred name
Address
Date of birth
Contact details HOME WORK
MOBILE EMAIL
Certificated Teacher Status ü Registration No. Expiry date
Certificated teacher
Provisionally certificated
Not certificated
Present Teaching Position
School
Date appointed
Type of appointment
Can we contact your principal about this position? YES NO
Date
Type of qualification Received from
received
Educational
Qualifications
Details of Training and Service
Please include details of your work history for the last 5 years.
SCHOOL POSITION DATES CLASS LEVEL
Please indicate any breaks in service and give reasons, e.g. overseas travel:
DATES REASON FOR BREAK
Total certificated service
A In permanent positions years months
B In relieving positions years months
Professional Development
Please provide a summary of recent professional learning and development.
CONFIRMATION
I certify that the information given in this application is, to the best of my knowledge, true
and correct. I understand that the claims made in my application may be checked.
1 YES NO
I understand that if I have supplied incorrect or misleading information, or have omitted
any important information, I may be disqualified from appointment, or if appointed, may
be dismissed.
2 I am currently registered to teach in New Zealand. YES NO
In accordance with the Privacy Act, I authorise the board of trustees to:
• Obtain further information from the referees listed in this application, and I
consent to the referees disclosing such information to the board
3 • Obtain information in relation to my application from persons not listed as YES NO
referees, and I consent to these persons disclosing pertinent information to the
board.
• Contact the Education Council.
STUDENT SAFETY
[Cross out the statement that does not apply to you]
• I have never been the subject of a complaint about the safety of a student.
4
• I have been the subject of a complaint about the safety of a student.
Please give dates and details:
OFFENCES AGAINST THE LAW
[Cross out the statements that don’t apply to you]
• I have never been convicted of an offence against the law (excluding minor traffic convictions).
• I have no pending charges of an offence against the law.
5
• I have been convicted of an offence against the law.
Please give dates and details:
• I have pending charges of an offence against the law.
Please give dates and details:
6 I know of no reason why I would not be suitable to work with children or young people. TRUE FALSE
Applicant’s signature Date
REFEREES
Please provide the names and contact details of three referees below. Referees’ reports are confidential
to the board. Referees will only be contacted for candidates who are short-listed.
REFEREE’S DETAILS
Full name
Position
Relationship to the
applicant
PRIVATE WORK
Contact details
MOBILE EMAIL
REFEREE’S DETAILS
Full name
Position
Relationship to the
applicant
PRIVATE WORK
Contact details
MOBILE EMAIL
REFEREE’S DETAILS
Full name
Position
Relationship to the
applicant
PRIVATE WORK
Contact details
MOBILE EMAIL
