Standing Tall, Promoting Excellence

Developing Understanding

APPLICATION FOR APPOINTMENT TO THE POSITION OF

Creative/Digital Technologies Teacher Permanent Part-Time

1. PERSONAL DETAILS:

Surname:______First Names:______

Title: ______Date of Birth: ______

Gender: ______Ethnicity: ______

Address: ______

______Email:______

Contact phone number: ( )______(home) ( ) ______(work)

______(Cell Phone)

N.Z. ResidentWork Permit

Disability that may require support - YES / NO (If yes, please specify)

______

______

What is your present state of health? ______

Have you had any significant time off for sickness of any kind in the past five years? If so, please specify. (Medical Certificate may be supplied)

______

______

2.STATUS: (please tick appropriate boxes)

Registered teacher (please enclose a copy of your current certificate)

Provisionally registered teacher (please enclose a copy of Provisional registration)

Not registered but have applied for registration (enclose of copy of application)

Not registered

3.DETAILS OF MOST RECENT EMPLOYMENT:

______

______

Date appointed: ______

Nature of position: (please tick appropriate boxes)

PermanentPart-timeFull-timeRelieving

Other(please specify) ______

  1. SUITABILITY FOR THE POSITION:

On a separate sheet please provide details as to why you believe you are suitable for this position. Please also ensure that your CV contains details of: Qualifications including conferring authority, teaching service including names of school/s year/s and subjects taught, Special duties performed and responsibilities undertaken, Co-curricular activities, Involvement in subject associations, teacher associations etc., Non-teaching work experience (paid/unpaid), including special goals, experience, strengths

  1. REFEREES: (You may nominate up to three referees who may be asked to supply confidential reports to our Board).

Name: ______Position: ______

Address: ______

Telephone:______(home) ______(work) ______(cell)

Your relationship to referee: ______

Name: ______Position: ______

Address: ______

Telephone:______(home) ______(work) ______(cell)

Your relationship to referee: ______

Name: ______Position: ______

Address: ______

Telephone:______(home) ______(work) ______(cell)

Your relationship to referee: ______

  1. TEACHING IN SPECIAL CHARACTER CATHOLIC SCHOOLS:

St Peter’s College is an IntegratedCatholicSchool. Please read “The Character of the CatholicSchool” included in the application pack and sign the following declaration.

I have read “The Character of the CatholicSchool” and understand the commitment it involves.

Signed: (Applicant)______Date: ______

  1. DECLARATION:

Have you ever been convicted of any offence against the law (apart from traffic convictions) or awaiting any possible pending charges YES / NO

Have you been the subject of any complaints concerning student safetyYES / NO

Have you been under competency proceedingsYES / NO

Have you ever been dismissed from a teaching positionYES / NO

Do you know of any reason why you should not be employed at the schoolYES / NO

I solemnly and sincerely declare that to the best of my knowledge and belief the information given is true and correct.

Signed: (Applicant) ______Date: ______

Note:

1.Purpose for which the information is collected. The information is collected for staff selection purposes. Please contact the College if you have any difficulty with the form.

  1. Storage. The information is held at St Peter’s College, Holdsworth Avenue, Palmerston North. It is accessible to members of the Appointments Committee and staff members directly involved in the appointment.
  1. I authorise St Peter’s College to seek information about my employment and personal background, and I understand that this information will be treated in complete confidence.

Signed: (Applicant)______Date:______