Application Form for Consultant

Application Form for Consultant

Please complete all sections of Part 1 and Part 2 of the application.

Please note that providing false information will result in the application being rejected or withdrawal of any offer of engagement, or immediate termination if you are already engaged. Checks may be carried out to verify the contents of your application form.Please complete the form on computer or in black ink. CV’s are not accepted.

PART 1

Applicant First Name / Family or Surname

1. ROLE APPLIED FOR AND FURTHER INFORMATION

Regions in which you would be prepared to work
Distance you would be prepared to travel to delivery consultancy
Are you able to work weekdays, evenings and weekends?

2.CURRENT / LAST APPOINTMENT(S):

Employed, self-employed or both? / Self-employed
Your role/title and the name, address and telephone number of current/last employer
and/or If self-employed your role/title and the names and telephone number of current/last major 3 clients / Role/title / Name, address & telephone
Role/title / Name
Employment title
Date appointed to current/last position/engagement
Permanent/Temporary
Full Time/Part Time
Current/last salary and If self-employed current hourly/daily rate(s)
If appointed when could you start as a consultant?

3. EMPLOYMENT, SELF EMPLOYMENT AND VOLUNTARY WORK HISTORY

Please provide a full history in reverse chronological order with an explanation for leaving each role.

NB. For current governance appointments please use Section 4

Job Title / Name and address of employer.
If self-employed the names of any major clients.
A description of your work activity in each case / Dates / Reason
or Position / From To / for
leaving
Mth / Yr / Mth / Yr
1
2
3
4
5
6

Please enclose a continuation sheet if necessary

4.Current Governance Roles

Please provide information about your current governance roles; please use a separate grid for each of your roles.

Name of school/trust at which you are a governor/trustee
If you are an academy committee (LGB) member, please give the name of your MAT as well as the name of your school
NGA school membership number (if applicable)
Maintained / SAT / MAT / AC
Phase of education
Type of governor/trustee
How long have you served on this governing board?
(since month/year)
Position held
If chair, how long have you been in this post? (since month/year)
Ofsted
Rating:
Date of inspection:
Next inspection due:
Risk of Requires Improvement I/Inadequate? (Please provide a realistic assessment.)
Any other information?

5.SECONDARY EDUCATION & QUALIFICATIONS

Name of School/College / From / To / Qualifications Gained with Date

6.HIGHER EDUCATION & ANY PROFESSIONAL QUALIFICATIONS

Names and Addresses of University or College and/or University Education Department / Dates
FromTo / Full or Part-time / Courses/subjects taken and Grade / Date of Examination and
Qualifications Obtained

7.PROFESSIONAL & TRAINING COURSES ATTENDEDPlease list relevant courses attended in past 2 years.

Subject / Organising Body / Date(s) / Duration

8. RELEVANT EXPERIENCE, INTERESTS AND SKILLS

Please tell us why you are interested in this position and why you think you would be suitable for it. Please indicate for each of the headings in the person specification how your skills, knowledge, attitudes and abilities are relevant to the post.Please give clear, specific examples and other evidence of how you meet each of the essential criteria. You should at least describe two recent pieces of development work that you have undertaken and their impact.

Please enclose a continuation sheet if necessary

9.REFEREES

Please give here details of two people to whom reference may be made.The first referee should normally be your present or most recent line manager or if, self employed, equivalent person. If you have been doing self-employed governance consultancy work for a school or have been involved in school governance then this would be from the chair of governors of the school or suitable alternative.Referees will amongst other things be asked about your good character and any disciplinary offences relating to children.References will not be accepted from relatives or from people writing solely in the capacity of friends.

First referee

Title and Name
Address and post code
Telephone number
Email address
Job Title
Relationship to applicant

Secondreferee

Title and Name
Address and post code
Telephone number
Email address
Job Title
Relationship to applicant

PART 2

This section will be separated from Part 1 on receipt.Relevant contents may be verified and used to check eligibility only.

10.PERSONAL INFORMATION

Surname or family name

All previous surnames

All forenames

Title

Current Address

Postcode

Resident at this address since

Home telephone number

Mobile telephone number

Date of Birth

Email address

National Insurance Number

Have you ever been subject to a child protection investigation by your employer or the Independent Safeguarding Authority?

/ YesNo
If YES please state separately under confidential cover the circumstances and the outcome including any orders or conditions.

Are you subject to any legal restrictions in respect of your employment in the UK?

/ YesNo
If YES please provide details separately

Do you require a work permit?

/ YesNo
If YES please provide details separately
16. Are you related to or have a close personal relationship with any employee or trustee of NGA? / YesNo
If YES give details separately under confidential cover

10.DECLARATION OF ANY CONVICTIONS, CAUTIONS OR REPRIMANDS, WARNINGS OR BINDOVERS

Please declareany unspent convictions, cautions or reprimands, warnings or bind-overs which you have ever had other than in relation to speeding offences and give details of the offences.The fact that you have a criminal record will not necessarily debar you for consideration for this appointment.

Do you have ANYunspent convictions, cautions or reprimands, warnings or bind-overs?

Please tick the relevant box

YesNo

If the answer is "yes", you must record full details in a separate, sealed envelope marked with your name and 'Confidential: Criminal Record Declaration' and enclose it with your application.

11.DATA PROTECTION ACT

The information collected on this form will be used in compliance with the Data Protection Act 1998.The information is collected for the purpose of administering the engagement of consultants.The information may be disclosed, you should also note that checks may be made to verify the information provided and may also be used to prevent and/or detect fraud.

12. DECLARATION

I certify that, to the best of my knowledge and belief, all particulars included in my application are correct.I understand and accept that providing false information will result in my application being rejected or withdrawal of any offer of engagement or termination if I am already engaged. I understand and accept thatchecks may be carried out to verify the contents of my application form

______

Signature of ApplicantDate

______

Print Name

PART 3Equal Opportunities Monitoring Form

NGA recognises that many individuals and communities experience unlawful and unfair discrimination and oppression. NGA recognises its legal responsibility to ensure that no unlawful discrimination occurs in the recruitment and selection process on the grounds of gender, race, disability, sexual orientation, religion or belief, or age. Equality of opportunity is an integral part of this recruitment and selection process.

It is NGA’s intention that all employees should have an equal chance of advancement, access to opportunity, and the training necessary to that end, irrespective of the employee's: gender, race, disability, sexual orientation, religion or belief, or age

In order to help NGA monitor its Equal Opportunities Policy, please complete this form. The NGA assures you that any information you provide here will only be used to monitor the effectiveness of our policies and we will take steps to ensure this information is treated in the strictness confidence. It plays no part in the selection process.

1.Ethnic Origin

Please chose one section A to F then tick the appropriate box to indicate your ethnic origin

A.Asian or Asian British

Bangladeshi
Indian
Pakistani
Any other Asian background, please write in box

B.Black or Black British

African
Caribbean
Any other Black background, please write in box

C.Chinese or other ethnic group

Chinese
Any other, please write in box

D.Mixed Heritage

White and Asian
White and Black African
White and Black Caribbean
Any other Mixed Heritage background, please write in box

White

British
English
Irish
Scottish
Welsh
Any other White background, please write in box

F.Prefer not to say

Prefer not to say

2.Gender

I am:

Female / Male / Prefer not to say

3.Disability

Do you have a disability?

Yes / No

Thank you for completing this monitoring form