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CONFIDENTIAL
SUPPORT STAFF APPLICATION FORM
(Before completing this form please read the Notes to Applicants)
Safeguarding Statement:
We are committed to safeguarding and promoting the welfare of children and young people and
expect all staff and volunteers to share this commitment.
Name of Candidate:
Masooda Jabarkhyl
TO BE USED FOR THE FOLLOWING POSITIONS ONLY:
Teaching Assistants
Welfare Assistant / Classroom Assistant (temporary or permanent)
Support Staff Member
Nursery Employee
School Business Manager
Early Years Practitioner
PLEASE MAKE SURE THAT YOU ARE USING THE LATEST VERSION OF THIS APPLICATION FORM
WHICH CAN BE DOWNLOADED FROM THE CATHOLIC EDUCATION SERVICE WEBSITE:
www.catholiceducation.org.uk
BEFORE YOU BEGIN PLEASE CHECK THAT YOU HAVE THE FOLLOWING:
1. Correct application form for the position being applied for
2. Notes to applicants
3. Recruitment monitoring form
4. Consent to obtain references form
PLEASE DO NOT RETURN ANY COMPLETED APPLICATION FORMS AND/OR SUPPLEMENTARY
DOCUMENTS TO THE CATHOLIC EDUCATION SERVICE. PLEASE RETURN ALL COMPLETED
APPLICATION FORMS AND/OR SUPPLEMENTARY DOCUMENTS TO THE
SCHOOL/COLLEGE/ACADEMY/MULTI ACADEMY TRUST COMPANY WHERE THE POSITION APPLIED
FOR IS BASED, OR AS INSTRUCTED IN THE DETAILS OF THE POST.
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PLEASE COMPLETE ALL SECTIONS OF THIS APPLICATION FORM FULLY BEFORE
RETURNING IT IF ALL SECTIONS ARE NOT COMPLETED YOUR APPLICATION
MAY NOT BE PROCESSED
DETAILS OF ROLE APPLIED FOR:
Application for the position of:
Early years teaching assistant
Full Time Part Time ✘ Job Share
At: Our Lady of the Visitation Catholic primary School / Academy
At which the:
Governing Body
Academy Trust Company
Multi-Academy Trust Company
is the employer of staff.
In the Local Authority of: Ealing
In the Archdiocese / Diocese of:
Please state where you first learned of this vacancy: From Ealing Council website
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Personal Details:
Title: Mrs
Surname: Jabarkhyl
First Name(s): Masooda
Known as (if applicable): N/A
Religious Denomination / Faith: Muslim
Address: Flat 12
Cleveland court
Ealing
Telephone Numbers:
Home: 02034893656
Mobile: 07411565653
How do you prefer to be contacted? Phone ✘ Email ✘
If you are a qualified teacher please complete the following section, if you are not, please proceed to
the next section:
DfE Teacher Reference Number:
Do you have Qualified Teacher Status? Yes No
QTS Certificate Number: Date of qualification as a teacher:
Education Workforce Council (Wales only) or other Membership Number:
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Details of Present Employment:
Are you presently employed: Yes No
If no, please proceed to the next section.
Details of present post:
Role:
Name of employer:
Name of school / Academy
(if applicable):
Address:
Telephone Number:
Local Authority
(if applicable):
Archdiocese / Diocese
(if applicable):
Permanent Temporary
Full time Part time Job share
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Description of key duties / responsibilities:
Date of appointment:
Notice required:
If notice already given, date
it is due to expire:
Reason for leaving:
Gross annual salary (include details of salary scale and spine point if applicable):
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Employment History and Work Experience:
Please complete in chronological order, starting with the most recent:
Employer’s name, address Full or Job title and Dates Reason for leaving
and nature of business part brief employed
time description of month / year
duties and (from – to)
responsibilities
Montpelier primary school Part Teaching 11/02/2019 I completed my
Montpelier Road time assistant To course
Ealing London (placement) 10/03/2020
W5 2QT part of my
Tel: 02089975855 course work
Stanhope primary school Part Teaching 10/09/2018 I completed my
Mansell Road, Greenford time assistant To course
UB6 9EG (placement) 19/06/2019
Tel: 02085759989 part of my
course work
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If there are any periods of time that have not been accounted for in your application, for instance,
periods spent raising a family or of extended travel, please give details of them here with dates. The
information provided in this form must provide a complete chronology from the age of 18. Please
ensure that there are no gaps in the history of your education, employment and other experience.
Failure to provide a full account may lead to your application being rejected.
Dates (from – to) Activity
09/2006 Completed my secondary education (A-level) in
Pakistan
2006/2008 Completed some English language and
computer courses
2008/2021 Raised my family and completed some courses
such as level 4 Early years Education, GCSE
maths, level 3 supporting teaching, GCSE
English, level 2 supporting teaching and
childcare level 1
If you have ever been ordained and/or been a member of a religious community please provide
details here:
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Post-11 education and training:
Please complete in chronological order, starting with the most recent:
Full name and address of Full or Dates Date of Awarding Award and
establishment part attended award body and classification
time month / registration
year number (if
From - to known)
Post-Graduate Qualifications (please state if you hold the Catholic Certificate of Religious Studies
(or equivalent))
Higher Education Qualifications
Level 4 Early Full time 05/10/202 Waiting Early years
years Education 0
University of To
West London 11/06/202
1
Level 3 Full time 10/09/201 14/06/2020 Cache (NCFE) Qualification
supporting 9 Level 3
teaching and To
learning 06/07/202
0
School / College Qualifications
GCSE Maths Part time 15/09/202 Waiting for Edexcel Waiting for
Southall college 0 certificate certificate
To
07/06/202
1
GCSE English Part time 09/09/201 June 2020 Edexcel Grade 4
Ealing college 9
To
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Level 2 Part time 04/06/202 23/08/2019 Cache (NCFE) Qualification
supporting 0
teaching 11/09/201
(Hammersmith 8
college) To
Part time 06/07/201 13/08/2018 Cache (NCFE) Qualification
Childcare level 1 9
Southall college
11/09/201
7
To
06/06/201
8
Continuing Professional Development
Please list any courses you have completed and/or any professional development in which you have
been involved in the past 3 years which you consider relevant to this post.
Course Title Course Length of Dates Award /
Provider Course From – To Classification (if
applicable)
Level 3 certificate Southall One day 04/11/2019
Safeguarding_2017_ver1 college
Level 2 certificate Southall One day 04/11/2019
Safeguarding_2017_ver1 college
Communication skills for Harrow 6 months 28/06/2013
teaching level 2/3 college
Please provide details of your most recent safeguarding training:
Safeguarding in Education by Montpelier primary school 18/12/2020
Professional Memberships:
Chartered College of Teaching:
Affiliate Associate Member (MCCT) Fellow (FCCT) Chartered Teacher (CTeach)
Please list any other professional bodies of which you are a member:
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Interests and Hobbies:
Please list your interests and hobbies outside of work:
Reading books, going shopping and watching TV.
Supporting Statement:
Please provide a written statement of no more than 1,300 words detailing why you believe your
experience, skills, personal qualities, training and/or education are relevant to your suitability for the
post advertised and how you meet the person specification applicable to the post.
I am a dynamic hard-working and motivating teaching assistant; my favourite subject is maths.
During my academic course I learned about children’s safeguarding, children’s right, Equality Act
2010 and equality duty, national curriculum, cognitive and physical development, role modelling
and some behaviourists theories. Also, I know about my responsibilities because all the adults
who work with children, they have responsibilities to keep children safe from harm and to support
them according to their individual needs.
I know that I should have a good knowledge about school’s policies to support children in an
appropriate way and I will try to have a right based approach, because children have rights to be
protected, to be understood, or to be heard. Also, I will consider and control a situation instead of
responding to it after it happens. As a teaching assistant I will treat children fairly, equally and I
will try to keep them safe from harm and provide them equal opportunities and a safer positive
and inclusive environment that support student’s well-being and achievement, without any
discrimination whatever their gender, religion, abilities, ethnicity, language and family background
is.
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References:
A referee who is a current or former employer should have full access to the applicant’s personal
records, to the extent that this is achievable in compliance with the General Data Protection
Regulation. Schools / Academies / Colleges of a Religious Character (in England only) are permitted,
when recruiting Support Staff to give preference to applicants who are Catholic where attaching this
requirement to the post is a proportionate means of achieving a legitimate aim (commonly known as
a “genuine occupational requirement”).
If you are a practising Catholic, you should nominate as one of your referees your Parish Priest / the
Priest of the Parish where you regularly worship.
If you are Catholic but do not consider yourself to be “practising”, you may (as an alternative to
nominating your Parish Priest as a referee), provide a copy of your baptism certificate, or the name
and address of the parish where you were baptised and the date of your baptism.
In requesting a Priest’s reference or baptismal information, it is not our intention to deter
applications and non-Catholics are welcome to apply. Please see the Notes to Applicants for further
guidance. It is the responsibility of the Applicant to ensure that all named referees, including Parish
Priests, where applicable, have consented to providing a reference. Please also ensure that you
complete and return the consent to obtain references form with your application.
In accordance with Keeping Children Safe in Education we will obtain and scrutinise references prior
to interview and referees will be contacted to provide further clarification as appropriate. All
information provided by referees will also be compared for consistency with the information you
provide on this form and you will be asked about any discrepancies. Please advise if you do not
want us to take up references at this stage and provide reasons.
Referees will also be asked for information about:
all disciplinary offences (including those where the penalty is “time expired” if related to
children); and
all child protection allegations including the outcome of any child protection investigations.
You are advised to read the relevant section of the Notes to Applicants before completing this
section.
If any of your referees knew you by another name please specify that name alongside the details of
the relevant referee.
Present School / Employer:
Name: Devbala Sanger
Address:
Southall college
Beaconsfield Road
UB1 1DP London
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Role: Tutor
Telephone: 02087411688
Email: [email protected]
Other Professional (where you are not currently employed with children, this must be your most
recent school / college / employer prior to your current employer):
Name: Catherine Dodd
Address:
Hammersmith college
Gliddon Road
W14 9BL London
Role: Tutor
Telephone: 02087411688
Email: [email protected]
Parish Priest / Priest of the Parish where you regularly worship (if applicable):
Name:
Address:
Role:
Telephone:
Email:
Please tick this box if you have enclosed a copy of your baptism certificate with this application form:
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If you have not nominated your Parish Priest as a referee and you have not provided a copy of your
baptism certificate please enter the name and address of the Parish where you were baptised and
the date of your baptism here:
If you or your spouse / civil partner / partner are related by marriage, blood or as a co-habitee to any
member of the Governing Body / Academy Trust Company / Multi Academy Trust Company or any
current employee(s) of the Governing Body / Academy Trust Company / Multi Academy Trust
Company please provide the relevant details here:
Name(s) of Governing Body / Academy Trust Company / Multi Academy Trust Company /
Employee(s):
Relationship(s) to you:
Disclosure of Criminal and Child Protection Matters and Disclosure and
Barring Service Checks
The Governing Body / Academy Trust Company / Multi Academy Trust Company is obliged by law to
operate a checking procedure for employees who have access to children and young people.
Please confirm whether you have ever been the subject of any child protection concern either in
your work or personal life, or been the subject of, or involved in, any disciplinary action in relation
thereto, including any which is time expired.
Yes No ✘
If yes please provide full details:
It is an offence to knowingly apply for, offer to do, accept, or do any work in a regulated position if
you have been disqualified from working with children. Any offer of employment will be subject
to checks being carried out in order to ensure that you are not subject to a prohibition order or an
interim prohibition order.
In the event of a successful application an offer of employment may be made to you which is
conditional upon receipt of satisfactory Disclosure and Barring Service Checks (“DBS Checks”) in
relation to criminal and child protection matters. Please note that a conviction will not necessarily
be a bar to obtaining employment.
By checking the box you consent to a DBS Check(s) being made:
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Rehabilitation of Offenders Act 1974
If you have any convictions, cautions, reprimands or final warnings that are not “protected” as
defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013
and 2020), then the details of these must be disclosed if you are invited for interview.
Guidance about whether a conviction or caution should be disclosed can be found on the Ministry of
Justice website.
If you are invited for interview, please bring The Rehabilitation of Offenders Act 1974 – Disclosure
Form with you to the interview in a sealed envelope marked “Confidential – Rehabilitation of
Offenders Act 1974 – Disclosure Form”. You will be asked to hand the form to the interviewer at the
end of the interview. If you do not have disclosable convictions, please complete the relevant
sections of the Disclosure Form.
Request for Your Consent to Process Your Data
In compliance with the General Data Protection Regulation (GDPR), we wish to ensure you are aware
of the purpose for which we are requesting your consent to collect and process the data we have
asked you to provide on this application form.
Important information regarding your consent
1. We are [insert name and address of school and state whether VA, Academy, Independent
etc. If you are part of a multi academy trust, state the registered name of the academy trust
company and state that the academy trust company is the data controller and explain that
the school is part of the multi academy trust].
2. Being a Catholic education provider we work closely with the school’s / academy’s Diocesan
Authority, the school’s / academy’s Trustees, the Local Authority, the Department for
Education, the Catholic Education Service and [insert name(s) of other relevant third
party(ies)] with whom we may share the information you provide on this application form if
we consider it is necessary in order to fulfil our functions.
3. The person responsible for data protection within our organisation is [insert name of data
protection officer] and you can contact them with any questions relating to our handling of
your data. You can contact them by [insert method of contact and contact details].
4. We require the information we have requested on this form in order to process your
application for employment.
5. To the extent that you have shared any special categories of personal data 1 this will not be
shared with any third party except as detailed in paragraph 2 above, unless a legal obligation
should arise.
6. If your application is successful, the information you have provided on this form will become
part of your personnel file which shall be retained throughout the duration of your
1
Article 9(1) GDPR sets out the special categories of personal data as follows: “personal data revealing racial or ethnic
origin, political opinions, religious or philosophical beliefs, or trade union membership, and the processing of genetic data,
biometric data for the purpose of uniquely identifying a natural person, data concerning health or data concerning a
natural person’s sex life or sexual orientation….”
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employment within our organisation and afterwards in accordance with our data retention
policy.
7. If you are unsuccessful, your application form and any documents you have submitted in
support of your application will be destroyed after a period of 6 months.
8. We will keep a record of your consent as evidence that we have obtained your consent to
collect and process the data you have provided on this application form.
9. You have the right to withdraw your consent at any time and can do so by informing our
organisation’s Data Protection Officer (see paragraph 3 above) that you wish to withdraw
your consent.
10. To read about your individual rights you can refer to our fair processing notice and data
protection policies.
11. If you wish to complain about how we have collected and processed the information you
have provided on this form, you can make a complaint to our organisation by [insert details
of the school / academy trust company / multi academy trust company complaints
procedure]. If you are unhappy with how your complaint has been handled you can contact
the Information Commissioner’s Office via their website at www.ico.org.uk.
Request for your consent
Please ensure that you read paragraphs 1-11 above and raise any relevant questions before
providing your consent below:
I confirm that I have read and understood paragraphs 1-11 above and that I have been
offered the opportunity to raise any relevant questions: Yes ✘ No
Please check this box if you agree to our collecting and processing your personal information
as described in paragraphs 1-11 above: ✘
I agree to my personal data being shared as stated in paragraphs 2 and 5 above: Yes ✘ No
Right to work in the UK.
The Governing Body / Academy Trust Company / Multi Academy Trust Company will require you to
provide evidence of your entitlement to undertake the position applied for and/or of your ongoing
entitlement to live and work in the United Kingdom in accordance with the current immigration
rules. More information can be found in the Notes to Applicants. By checking the box below, you
confirm that you are legally entitled to work in the United Kingdom and that you will promptly
provide documentary evidence of such entitlement when requested: ✘
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Language requirements for public sector workers.
The ability to communicate with members of the public in accurate spoken [English / Welsh] is an
essential requirement for the post. This is because this is a public facing public sector post. Please
note that this language requirement may be in addition to mandatory English language
requirements associated with your immigration route.
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Declaration
If you know that any of the information that you have given in this application form is false or if you
have knowingly omitted or concealed any relevant fact about your eligibility for employment which
comes to our attention then your application form may be withdrawn from the recruitment process.
Please note that checks may be carried out in order to verify the information you have included.
Providing false information is an offence and may result in this application being rejected. If such a
discovery is made after you have been appointed then you may be liable to be dismissed summarily.
You may also be reported to the Teaching Regulation Agency (TRA) (England only) or the Education
Workforce Council (Wales only) and/or the Police, if appropriate.
By signing below I hereby certify that all the information given by me both on this form and in any
supplementary pages and/or the supporting evidence provided, is correct to the best of my
knowledge and belief, that all the questions relating to me have been fully answered and that I
possess all the qualifications that I claim to hold.
I acknowledge that it is my responsibility as the applicant, if invited for interview, to disclose
information to the panel which may affect my suitability and/or eligibility to work with children
and/or vulnerable adults.
Signature: Masooda
Date: 25/06/2021
(The post will be subject to the terms and conditions of the appropriate Catholic Education Service
model contract, a copy of which will be provided to you before interview if you are shortlisted).
Model Application Form – Support Staff – September 2013 – updated December 2020
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