Queen Ethelburga’s Collegiate Foundation
Thorpe Underwood Estate

Thorpe Underwood

York

YO26 9SS

Please complete this summary form in addition to providing full Curriculum Vitae

POSITION APPLIED FOR
1. PERSONAL INFORMATION
Forenames

Date of Birth

National Insurance No / Surname
Former Name
(If applicable)
Marital Status
DFES No
DFES No
Address /

Tel. No.

E Mail Address

______
Current Salary
Do you have a full driving licence? /

Do you own your own transport?

2. EMPLOYMENT INFORMATION

Present

Position /

Date of

Appointment

Employer’s

Name
And Address

Summary of

Responsibilities
And
Experience
3. QUALIFICATIONS: Do you have QTS? Yes/No

Higher Education

Qualifications
(with grades, dates & institution)

Post-

Graduate
Qualifications
(with dates & institution)
Specialist
courses
attended
in the last 5 years
ICT knowledge / Please circle the options that best apply to you.
Prepared to lead ICT staff INSET / Regularly use IT in lessons / Occasionally use IT in .lessons / Rarely use IT in lessons / Confident user of IT for admin / Nervous user of IT for admin
Hobbies and interests

4. EMPLOYMENT HISTORY

Teaching

Dates /

School

/

Position Held

Non-Teaching

Dates / School / Position Held
5. EXAM RESULTS RECORD
Please fill in the boxes below for all exam groups for which you were responsible
A level (Last 3 years) / 20__ / 20__ / 20__

Number of candidates starting the course

Number of candidates finishing the course
Number of A* grades
Number of A grades
Number of B grades
Number of C grades
Number of D grades
Number of E grades
GCSE (Last 3 years)
Number of candidates starting the course
Number of candidates finishing the course
Number of A* grades
Number of A grades
Number of B grades
Number of C grades
Number of D grades
Number of grades below D
BTEC (Last 3 years)
Number of candidates starting the course
Number of candidates finishing the course
Number of D* grades
Number of M grades
Number of P grades
Key Stage Sats. Please provide the % of each grade
Key Stage 1
Key Stage 2
Teaching subjects
Please list all subjects you are qualified to teach and to what level
Subject / Level / Qualifications / Experience
6. medical /safeguarding history
Please note that the successful applicant will be required to complete a questionnaire for consideration by an appointed Medical Officer in order to satisfy the Education (Health Standards) (England) 2003. QE will fully comply with its duties under the Disability Discrimination Act.
7. References
Name / Name
Address / Address
Phone number / Phone number
Email address / Email address
May we contact prior to interview / Yes { } No { } / May we contact prior to interview / Yes { } No { }

This post is exempt from the Rehabilitation of Offenders Act 1974 and all convictions, cautions and bind-overs, including those regarded as ‘spent’, must be declared. We require a signed statement that you are not on List 99, disqualified from working with children, or subject to sanctions imposed by a regulatory body, e.g. the General Teaching Council (GTC). You must also inform us if you ever had a concern raised about your behaviour towards a child or children? You must either have no convictions, cautions, or bind-overs, or have attached details of your record in a sealed envelope marked confidential.

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