Internal use only
Reference no:
Date received:
References sought:
SHIRLEY HIGH SCHOOL PERFORMING ARTS COLLEGE
Employment Application Form: Teacher
We are committed to safeguarding and promoting the welfare of children and young people and
expect all staff and volunteers to share this commitment.
Please ensure that you complete all sections of Part 1 and Part 2 of the application. Please note
that providing false information will result in the application being rejected, withdrawal of any offer
of employment, summary dismissal if you are in post, and possible referral to the police. Please
note that checks may be carried out to verify the contents of your application form. Please
complete the form in black ink or type. CVs are not accepted.
Vacancy Job Title
Part 1: Information for Shortlisting and Interviewing
Initials Surname or Family Name
1. Letter of Application
Please enclose a letter of application. Please refer to the applicant information pack which
may include instructions on how to complete the letter of application.
2. Current/Most Recent Employment: If Teaching
Name, address and telephone number of
school
Type of school Boys Girls Mixed Age range
Number on Roll
Type of school e.g. Community, Aided,
Academy, Foundation, Free School,
Independent, etc.
Job title
Please enclose a copy of the job description
Subjects/age groups taught Full or part time:
Date appointed to this post
Salary
Date available to begin new job
3. Current/Most Recent Employment: If Non-Teaching
Name, address and telephone number of
employer
Job title
Please enclose a copy of the job description
Date appointed to this post
Salary
Date available to begin new job
4.
5. Full Chronological History
Please provide a full history in date order, most recent first, since leaving secondary education,
including periods of any post-secondary education/training, and part-time and voluntary work as
well as full time employment, with start and end dates, explanations for periods not in
employment or education/training, and reasons for leaving employment.
Job title Name and address of Number on Full Dates (DD/MM/ Reason
or positon school, roll and or YYYY) for
other employer, or type of part- From To leaving
description of activity time
school, if
applicable
Please enclose a continuation sheet if necessary.
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6. Secondary Education and Qualifications
Name of school/college From To Qualifications gained
with date
7. Higher Education
Name and address Dates Full or Courses/ Date of Age
of university, college part- subjects taken examination groups for
and/or university time and passed and which
education From To qualifications trained
department obtained
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8. Professional Courses Attended as a Teacher
Subject Organising body Date(s) Duration
9. Other Relevant Experience, Interests and Skills
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10. Referees
Please provide details of two people to whom reference may be made. The first referee should
normally be your present or most recent Headteacher or equivalent person. If you are not
currently working with children please provide a referee from your most recent employment
involving children. Referees will be asked about all disciplinary offences which may include
those where the penalty is “time expired” if related to children. Referees will also be asked
whether you have been the subject of any child protection concerns, and if so, the outcome of
any enquiry. References will not be accepted from relatives or from people writing solely in the
capacity of friends.
It is normal practice to take up references on shortlisted candidates prior to interview. This is in
line with the most recent version of Keeping Children Safe in Education statutory guidance.
First Referee
Title and name
Address and post
code
Telephone number
Email address
Job title
Relationship to
applicant
I consent to this reference being requested before interview.
Yes No
Second Referee
Title and name
Address and post
code
Telephone number
Email address
Job title
Relationship to
applicant
I consent to this reference being requested before interview.
Yes No
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Part 2 Internal Ref. No.
This section will be separated from Part 1 on receipt. Relevant responses may be verified prior to
shortlisting and/or used for administration purposes but will not then be used for selection
purposes.
11. Personal Information
1. Surname or family name
2. All forenames
3. Title
4. Current address
5. Postcode
6. Home telephone number
7. Mobile telephone number
8. Email address
9. DfE reference number
10. Do you have a current full clean Yes No
driving licence? Only applicable for
posts that require driving
11. Do you require sponsorship (previously Yes No
a work permit)?
If YES please provide details under separate
cover.
12. How did you hear about this position? TES CHTA Croyd School Other
Tick the appropriate box on Websi
Counci te
l
Websit
e
12. Compulsory Declaration of any Convictions, Cautions or Reprimands, Warnings
or Bind-overs
It is the School’s policy to require all applicants for employment to disclose any previous ‘unspent’
criminal convictions and any cautions which have not expired, or any pending prosecutions. In
addition, the job you are applying for is exempt from the provisions of the Rehabilitation of
Offenders Act 1974 (exceptions order 1975) which requires you to disclose all spent convictions
and cautions except those which are ‘protected’ under Police Act 1997 – Part V and the
amendments to the Exceptions Order 1975 (2013) and are not subject to disclosure to employers
on DBS certificates and cannot be taken into account. Guidance on the filtering of “protected”
cautions and convictions which do not need to be disclosed by a job applicant can be found on the
Disclosure and Barring Service website.
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If you are invited to interview you will be required to disclose your criminal record on an “Invitation
to Interview” form and bring the completed form to interview. If the job involves contact with
children up to age 8 you will also be required to make a Disqualification Declaration. The
information you give will be treated as strictly confidential. Disclosure of a conviction, caution,
bind-over order, warning or reprimand will not automatically disqualify you from consideration.
Any offence will only be taken into consideration if it is one which would make you unsuitable for
the type of work you are applying for. However, offences relating to children may make you
unsuitable since this is a “regulated position” under the Criminal Justice & Courts Services Act
2000.
13. Prohibition from Teaching
In accordance with the requirements of The School Staffing (England) (Amendment) Regulations
2013, any future appointment is subject to a check with the Department for Education to ensure
that you are not subject to a prohibition order or an interim prohibition order.
14. Data Protection
The information collected on this form will be used in compliance with Data Protection regulations.
By supplying information, you are giving your consent, if appointed, to the information being
processed for all employment purposes as defined by statute. The information may be disclosed,
as appropriate, to the governors, to Occupational Health, to the Teachers Pensions Agency, to the
Department for Education, to pension, payroll and personnel providers and relevant statutory
bodies. This form will be kept strictly confidential but may be photocopied and may be transmitted
electronically for use by those entitled to see the information as part of the recruitment process.
When the recruitment process is completed, your form will be stored securely for a maximum of
six months then securely destroyed, unless you are employed as a result of this recruitment
process in which case this application form will be retained as part of your personnel record.
15. Notes
(a) Under the Criminal Justice & Courts Services Act 2000 it is an offence for an individual who
has been disqualified from working with children to knowingly apply for, offer to do, accept,
or do any work in a ‘regulated position’. The position you are applying for is a “regulated
position”.
(b) Canvassing, directly or indirectly, an employee or governor will disqualify the application.
(c) Candidates recommended for appointment will be required to provide a satisfactory
Enhanced DBS certificate and complete a pre-employment medical questionnaire and may
be required to undergo a medical examination.
(d) This organisation is under a duty to protect the public funds it administers, and to this end
may use the information you may provide as part of the recruitment process for the
prevention and detection of fraud. It may also share this information with statutory bodies
responsible for auditing or administering public funds for these purposes.
16. Declaration
I certify that, to the best of my knowledge and belief, all particulars included in my application are
correct. I understand and accept that providing false information will result in my application being
rejected or withdrawal of any offer of employment, or summary dismissal if I am in post, and
possible referral to the police. I understand and accept that the information I have provided may
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be used in accordance with paragraph 13 above, and in particular that checks may be carried out
to verify the contents of my application form.
Signature of Applicant:
Print Name:
Date:
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Part 3: Equality and Diversity Monitoring
This section will be separated from part 1 and part 2. Collection of equality information is solely for
monitoring purposes to ensure that our policies and procedures are effective. We also collect this
data in accordance with the general and specific public sector equality duties under the Equality
Act 2010. Any data you enter onto this monitoring form will only be used for monitoring purposes
and will not be used in assessing and or scoring your application or during the interview process.
This information is kept fully confidential and access is strictly limited in accordance with the Data
Protection Act.
Ethnicity Workforce census code Pleas Sexual Please
e tick orientation tick
White WBRI British English Welsh Northern Irish Bi-sexual
Scottish Gay Man
WIRI Irish Gay Woman
WIRT Traveller of Irish Heritage Heterosexual
WRO Gypsy / Roma Other
M
Prefer not to say
WOTH Any other White background
Mixed MWBC White and Black Caribbean
MWBA White and Black African Gender Please
MWAS White and Asian tick
MOTH Any other Mixed background Female
Asian or AIND Indian Male
Asian Transgender
British
Prefer not to
APKN Pakistani say
ABAN Bangladeshi
CHNE Chinese
AOTH Any other Asian background
Black or BCRB Black – Caribbean Personal Please
Black relationship tick
British Single
BAFR Black – African Living together
BOTH Any other Black background Married
Other ARAB Arab Civil
ethnic CHNE Chinese Partnership
group REFU Refused/Prefer Not to Say Prefer not to
OOTH Any other ethnic group say
Disability Please tick
Do you consider that you have a
disability?
Religion or belief Please
tick Yes - Please complete the grid
below
No religion
No
Christian (including Church of
Prefer not to say
England, Catholic, Protestant
and all other Christian
denominations) My disability is:
Buddhist Physical Impairment
Hindu Sensory Impairment
Jewish Mental Health Condition
Muslim
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Sikh Long standing illness
Any other religion (Write in) Other
Prefer not to say Prefer not to say
