LANCASTER ROYAL GRAMMAR SCHOOL

SUPPORT STAFF APPLICATION FORM

Lancaster Royal Grammar School is committed to safeguarding and promoting the welfare of children and young people and expects all staff and volunteers to share this commitment.

APPLICATION FOR APPOINTMENT AS: Learning Support Assistant

1. Personal Details:
Title …………………………… First Names ………………………………………
Surname ………………………………………………….
Have you ever used any other names? YES/NO (delete as appropriate)
If YES please state (in full) …………………………………………………………………….
Address ……………………………….. Telephone (Home) ……………………………..
………………………………………… Telephone (mobile) ……………………………
………………………………………… E-mail (Personal or Work – please specify)
………………………………………… …………………………………………………
Post Code …………………………….. National Ins No ……………………………….
2.  Name and Address of present employer
……………………………………………………………………………………………………
…………………………………………………………………………………………………….
Post held ……………………………………… Salary …………………………………..
Dated started…………………………………
3.  Previous employment
Please list all appointments starting with most recent:
Name and address of employer / Dates / Post details
From day/month/year / To day/month /year
4  Breaks from employment
If you have had any breaks in employment since leaving school, please give dates and details of your activities during these times, eg unemployment, raising a family, study, voluntary work, etc.
Dates / Details of appointment/reason for break
From
day/month/year / To day/month/year
5  Secondary schools
Schools / From / To / Qualifications obtained (including grades)
6  FURTHER EDUCATION
Colleges/Universities / From / To / Qualifications obtained (including grades)

Please write any additional information on the continuation sheet on the back page.

7  DETAILS OF ANY OTHER TRAINING OR QUALIFICATIONS NOT COVERED IN PREVIOUS SECTIONS:
8 PLEASE SUPPLY THE NAMES AND ADDRESS OF THREE PEOPLE (ONE OF WHICH MUST BE YOUR PRESENT EMPLOYER), TO WHOM THE APPLICATION MAY BE MADE FOR A REFERENCE:
i)  Name and address ……………………………………………………………………………………………….
……………………………………………………………...Email address ………………..
Post code …………………………………… Telephone number …………………
ii)  Name and address……………………………………………………………………………
…………………………………………………………… Email address…………………
Post code …………………………………… Telephone number ………………...
iii)  Name and address…………………………………………………………………………..
………………………………………………………… Email address……………………
Post code ………………………………………… Telephone number …………………..
* Please indicate if you do not wish your current employer to be contacted.

9 DISCLOSURE OF CRIMINAL CONVICTIONS AND REHABILITATION OF OFFENDERS ACT 1974

The post for which you are applying will involve access to children and will be subject to the receipt of a satisfactory enhanced disclosure from the Disclosure and Barring Service (formerly CRB). You are required to declare any convictions, cautions or reprimands, warnings or bind-overs even if they would otherwise be regarded as “spent” under the Act. Please tick one of the following below:

I have nothing to declare

I have information to declare and have attached a sealed envelope containing details

10 DO YOU HOLD A CURRENT DRIVING LICENCE? YES/NO (delete as appropriate)

11. ARE THERE ANY SPECIAL FACILITIES YOU WOULD LIKE US TO PROVIDE TO HELP YOU ATTEND OR PARTICIPATE IN AN INTERVIEW, OR TO PERFORM THIS JOB? / YES/NO
If YES please give details here

12 ASYLUM AND IMMIGRATION ACT 1996

Do you need a Work Permit or Worker

Registration Certificate to work in the UK YES/NO (delete as appropriate)

13 EXISTING CONTACTS WITHIN SCHOOL
Please indicate if you know any existing members of staff or Governors at the school, and if so how you became acquainted.

Lancaster Royal Grammar School supports the principle of equal opportunities in employment and a copy of the Lancaster Royal Grammar School Equal Opportunities policy is available on request.

14 DECLARATION

I understand that any offer of employment will be subject to the information on this application form being complete and correct. I authorise Lancaster Royal Grammar School to make any appropriate checks which may be necessary in relation to the post I have applied for. False information, or a failure to supply the details required in this application form could make an offer of employment invalid or lead to termination of employment.

I agree that personal data relating to me which has been, or is obtained by Lancaster Royal Grammar School, including personal data given by me on this form, may be held and processed either on a computer or in manual records and may be disclosed to Governors and authorised employees of the school and used by the school for any purpose relating to my application and prospective recruitment and employment within the school.

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

Candidates are expected to write a letter in support of their application and supply a full curriculum vitae.

The letter, curriculum vitae and application form, in an envelope marked PRIVATE and CONFIDENTIAL, should be forwarded to

Mrs Jayne S Stirzaker

PA to the Bursar, Clerk to the Governors and the Business Controller

Lancaster Royal Grammar School

Lee House

East Road

LANCASTER

LA1 3EF

To arrive by Friday 26th June 2015.


CONTINUATION SHEET

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