Application Form

Location:* Application for appointment as: Closing date:

Personal Details

Title* First Name Last Name* Date of Birth Email* Contact telephone Work telephone Address (line 1)* Address (line 2) Town / City Postcode* National Insurance Number*

If you do not wish to be contacted at workPlease tick

Present Employment

	If you are currently employed please give employer's name and address.
Nature of business
Job title
Date appointed
Grade / Salary spine
Current salary (point)
Notice required
Allowance(s) received:Type(s)
Allowance(s) received:Value(s)
Reason for leaving

Brief outline of duties in your current or most recent job*

Previous Employment

Please include all full time and part time positions. Please list the most recent first and continue on a separate sheet if necessary.

*

	Employer	Start date	End date	Job Title	Salary	Reason for leaving
1
2
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Breaks in Employment History

If you have had any breaks in employment since leaving school, give details of these periods and your activities during these times e.g. unemployment, raising family, voluntary work, training.

Please give details

Mobility

Please complete this section if the post includes these requirements

Do you have a valid driving licence?*YesNo

Do you have access to a vehicle which you are able to use for work purposes?*YesNo

If not, are you able to travel, for work purposes, by another means of transport?*YesNo

Secondary School Education

(Please list most recent first)*

	Schools(s)	From	To	Qualifications/Subjects Obtained and awarding body	Grade	Dates
1
2
3
4
5
6
7

Continuing Education

(University/College/Apprenticeships etc.)

(Please list most recent first)*

	Schools(s)	From	To	Qualifications/Subjects Obtained and awarding body	Grade	Dates
1
2
3
4
5
6
7

Professional qualifications

including details of professional Association membership

Do you hold Qualified Teacher Status (QTS)*YesNo

If yes, please complete the following:

Please give your Teacher Ref number: Date Statutory Induction Period (if qualified since August 1999) started:

Other relevant training and development activities attended in the last five years

Please list the most recent first and continue on a separate sheet if necessary

	Brief description/Course title	Date	Organising body
1
2
3
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5

Information in support of this application

Please use the job description/person specification as a prompt to describe the experience, skills, competencies and qualifications that make you suitable for this job. These may have been gained from your work experience, any voluntary or community work or any other organisation you may have been involved with. You should ensure that any information submitted reflects your experience relating to the competencies that are detailed in the Job Description.
(Please continue on a separate sheet if necessary). If you are a teacher, please provide details of any specialist teaching experience/skills you possess that may be relevant to the post.

Please type here Accompanying document if needed No file chosen

References

Please give the names and addresses of your two most recent employers (if applicable). If you are unable to do this, please clearly outline who your references are.

Please rate the following*

	Name and address:	Position:	Telephone number:	Email address:
Reference 1
Reference 2

Note
(i) Referees will be contacted before interviews.
(ii) If either of your referees know you by another name please give details.
(iii) The school may contact other previous employers for a reference with your consent.
(iv) References will not be accepted from relatives or from people writing solely in the capacity of friends.`

Close personal relationships

Are you a relative or partner, or do you have a close personal relationship with, any employee or Governor of the establishment to which your application is being made or to any County Councillor or employee of Essex County Council?

*YesNo

If ‘yes’ please state the name(s) of the person(s) and relationship.

Failure to disclose a close personal relationship as above may disqualify you. Canvassing of Governors, County Council or Senior Managers of the School/Essex County Council by or on behalf of is not allowed.

Please read the following statements and information relating to your application carefully. By signing and submitting this form you certify and confirm the declarations are true to the best of your knowledge.

Declaration

I certify that, to the best of my belief, the information I have provided is true and I understand that any false information will result, in the event of employment, in disciplinary investigation by the School, and is likely to result in dismissal.

Disclosure of Criminal Convictions

Short-listed candidates will be asked to complete a Self-Disclosure Form (SD2) and, where appropriate, a disclosure/status check will be sought from the Disclosure and Barring Service in the event of a successful application. A conviction/caution/reprimand will not necessarily be a bar to obtaining employment.

Safer Recruitment and Childcare Disqualification Checks

I certify that I am not disqualified from working with children or subject to sanctions imposed by a regulatory body which would restrict me from applying for this post.

Short listed candidates applying for a relevant post in a school setting covered by the Childcare (Disqualification) Regulations 2009 (“the Regulations”) will be asked to complete a Disqualification Declaration Form. A disqualified person may only be employed in a relevant post if they obtain a waiver from Ofsted. By signing this application form you acknowledge and consent to completing the Disqualification Declaration Form if you are shortlisted for a relevant post in a setting covered by the Regulations.

Data Protection Act 1998

I hereby give my consent for personal information (including recruitment monitoring data) provided as part of this application to be held on computer or other relevant filing systems and to be shared with other accredited organisations or agencies in accordance with the Data Protection Act 1998.

Correspondence

Thank you for applying for this post. Your interest in working for us is very much appreciated. It is not our practice to acknowledge receipt of applications. However, if you would like to be informed of the outcome of your application once the selection process has been completed, then please enclose a stamped addressed envelope.

Please tick to sign*signed

Disability

Before ticking the appropriate box below please read the definition of disability.

The definition of disability, as outlined in the Disability Discrimination Act 1995 is as follows:
“a physical or mental impairment which has a substantial and long term adverse effect on a person’s ability to carry out normal day-to-day activities”.

To be protected under the Act.

• An individual must have an impairment which can be physical or mental.
• It has to be substantial, that is something more than minor or trivial.
• It needs to be long term i.e. the impairment has lasted or is likely to last in total for at least twelve months or more, or is likely to last for the rest of the life of the person affected (long term includes conditions which fluctuate or may recur such as cancer, HIV/Aids and multiple sclerosis) and
• It must affect their day-to-day activities on a regular basis (day-to-day activities includes things such as reading, lifting and carrying objects, personal care, shopping, meeting and communicating with people. The effect of your impairment on everyday activities is considered as it would be without medication or aids. The only exception is eyesight which should be judged when an individual is wearing their usual lenses or spectacles).

*I do consider myself to have a disability as defined by the Disability Discrimination Act 1995 (as detailed above).I do not consider myself to have a disability as defined by the Disability Discrimination Act 1995 (as detailed above).I prefer not to say.

Data Protection Act

I hereby give my consent for the Recruitment Monitoring Information provided on this form to be held on computer or other relevant filing systems and to be shared with other accredited organisations or agencies in accordance with the Data Protection Act 1998.

Please tick to sign*Signed

PCLC Trust

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