Higher Level Teaching Assistant Application Form 2017 to 2018

Section 1: To be completed by the Applicant

Title (tick one) / Mr / Mrs / Miss / Ms / Other
First name(s): / Family Name:
Residence name/number:
Address:
City/Town:
County: / Postcode:
Contact telephone number: / Contact e-mail address:
What is your current job title? / When did you start your current role? (MM/YYYY) / ___/______
Name of school/organisation: / DfE No
Address:
City/Town:
County: / Postcode:
Telephone number: / e-mail address:

Please tick the box that best describes your employer

Infant school / Junior School / Primary School / Secondary School
Special School / Other Educational Institution
Special Requirements
Should your application be successful do you have any specific access or dietary requirements?
Please indicate below:
Payment arrangements
Payment for 3 day preparation / Invoice Name ………………………………………………………………………….
Invoice address……………………………………………………………………….
Email ………………………………………………..………… IBC school ..Yes/No..
Payment for assessment visit / Invoice Name ………………………………………………………………………….
Invoice address……………………………………………………………………….
Email ………………………………………………………….. IBC school.. Yes/No..

Candidate’s declaration

The information I have given on this form is correct to the best of my knowledge.
Signed: / Date: / / /
Section 2 To be completed by the Headteacher (of the school in which the applicant is currently employed)

Head teacher’s declaration

Please describe how the role of HLTA applied for will support pupil attainment in your school
I confirm that I have read the HLTA standards in relation to this applicant, support the application of the above named and that the information I have given on this form is correct to the best of my knowledge.
Headteachers Name
Signed:
Date: / /

Please send complete application:-

§  Application form showing details for invoicing

§  Completed Readiness analysis

§  Copies of maths and English certificates for standard 11

To HLTA Applications, Clarendon House, Monarch Way, Winchester SO22 5PW.

If ‘not accepted ’ reason and action points………………

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Signed …………………………………….. Date ………………………………..