BROOMFIELD SCHOOL A FOUNDATIONSCHOOL

Please complete this form fully even if you are enclosing a C.V. using black ink for ease of photocopying.

Job applied for: ......

  1. Personal details (BLOCK CAPITALS PLEASE)

Surname: / Other names: / Title:
Address: / Telephone number:
Home: Email:
Work/School:
Date of birth: / National insurance no:
DFE reference No: / Registered Disabled (Yes/No):
Registered Disabled persons No:
Date of qualification as a recognised teacher:
Current school: / Current post:
No on roll: / Boys/girls/mixed:
Age range: / Age range taught:
Date of appointment to present school: / Date of appointment to present post:
Current CPS point held: / Incentive allowance held:
Current gross salary:
Please give details of any absences exceeding two weeks
Please give details of your present post, to include main duties and responsibilities
2.Previous Teaching Experience- Chronological order – ending with the most recent
(Please list teaching practice if Newly Qualified)
SCHOOL
(Incl. Roll) / Post/scale held / Boys/Girls
Mixed / AgeRange / Subject(s) taught / From:
To:

3.Courses attended within the past five years (continue on a separate sheet if necessary)

Course Details /

Dates

Please give details of Schools/Colleges etc. attended, including professional and technical training.

  1. Education – Secondary and Higher Education

Name of School / Dates / Examinations passed.
Please show date of passing and grade
From / To
University/College / Dates / Qualification inc. Class/MainSubject & subsidiary subject.
From /

To

If you have been employed outside the teaching profession at any time since the age of 18yrs please complete below
Name of Employer / Nature of work / Dates

5.Referees (please see notes)

First referee

/

Second Referee

Telephone No: / Telephone No:
Fax No: / Fax No:
6. Statement in support of application
On a separate sheet, please write a statement in support of your application.
Any relation ship to a Governor, or Senior Member of the School Staff should be declared here (or enter NONE”)
I certify that, to the best of my knowledge, the information I have entered is true and I understand that any false information or failure to disclose criminal activities may result in dismissal or disciplinary action being taken.
Signed:______Date: ______

Notes:

  1. References

All referees should be professional rather than personal ones.

The Head Teacher of your present or most recent school is the appropriate first referee the second referee is optional

If you have not previously held a teaching post, the name and postal address of the Principal of your institution should be given as the first referee. Heads of Department or other persons may be given as a second referee.

  1. Rehabilitation of Offenders Act/Police Screening

Because of the nature of the work for which you are applying, the post is exempt from the provisions of Section 4 (2) of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. Applicants are, therefore not entitled to withhold information about convictions which for other purposes are ”spent” under the provisions of the Act. In the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action being taken. Information may be set out or details given at interview. This will be confidential and will be considered only in relation to an application for a position to which the Order applies.

A check as to possible criminal background is initiated with police upon offer of appointment as a teacher and subsequently destroyed. Offers a re subject to such a check proving satisfactory.

It should not be assumed that a conviction will automatically rule out an appointment, but it must be stated openly in order for a decision to be made as to a candidate’s suitability.

  1. Health Screening

Successful candidates will also be expected to complete a Health Questionnaire.