ST. FRANCIS XAVIER’S COLLEGE

CATHOLIC ACADEMY

WOOLTON HILL ROAD
LIVERPOOL

L25 6EG
Tel 0151 288 1000

Fax 0151 288 1001
Email

Website

1842

EXECUTIVE HEADTEACHER

MR LD RIPPON, B.A. Hons, N.P.Q.H.

HEAD OF SCHOOL

MR G FLOWERS, B.A. Hons, N.P.Q.H. M.A.

Application for the position of:Teacher of English
PERSONAL DETAILS
Surname: ……………………………..…………….
Address: …………………………………………….
………………………………………………………...
County: …...…………………………………….....
Postcode: ......
Date of Birth: ……………………………..…...….
NI Number: …………………………………….….. / Title (Mr, Mrs, Miss, Ms, Dr, Other): …………..
Forename(s): ……………………………………..
Tel No (Home):......
Tel No (Work/Mob):.....…………………......
Email: ……………………………………………..
DFE No: ………………………………………......
DBS(CRB) Cert no: ......
DBS (CRB) Cert Date: ......
EDUCATION (POST AGE 16)
Institutions(s) attended
/ Dates / Qualifications Gained(Class of degree and examination grades)
From / To
Please include any higher degrees in this section
PROFESSIONAL TRAINING
(Please include initial training and any major staff development courses completed over the last 3 years which you consider may be relevant to the post)
Institution Attended / Course / Date
NB. Shortlisted candidates will be asked to bring original certificates to interview.
MEMBERSHIP OF PROFESSIONAL BODIES
Name of Body / Grade (if appropriate) / Date
INTERESTS (e.g. hobbies, sports, voluntary work)
CURRENT/LAST EMPLOYMENT
Employer’s Name: ……………………………….
Employer’s Address: ……………………………
Town: ………………………………………………
County: ………………Postcode: ……………...
Phone: ………………………………………………
School Name: ……………………………………...
School Type: ……………………………………….
(e.g. VA, Foundation or Community) / Position: …………………………………………..
Grade: …………….. Salary: ………………….
Date Commenced: ………………………………
Period of Notice: …………………………………
School Email: ……………………………………...
School Age Range Taught: ……………………...
Approximate Number of Pupils: ………………..
BRIEF DESCRIPTION OF DUTIES/RESPONSIBILITES
PREVIOUS EMPLOYMENT (chronologically listed. )
Employer’s Name & Address / Dates / Position / Brief outline of responsibilities
From / To
REFEREES
Please give the names, addresses, occupation and emailof two referees, one of whom should be your present or last employer
(1) / (2)
Name: …………………………………………
Address: …………………………………………
………………………………………………………...
……………………….Post Code ……..………......
Tel No: ………………………………………………
Fax No: ………………………………………………
Email: ......
Occupation: ……………………………………….. / Name: ………………………………………….
Address: …………………………………………..
………………………………………………………..
Town:…………………..Post Code: ……………..
Tel No: ………………………………………………
Fax No: ………………………………………………
Email: ......
Occupation: ………………………………………
OTHER DECLARATIONS
1.
2
3 / The appointment for which you are applying involves work with children and is therefore exempt from the Rehabilitation of Offenders Act 1974. You are required to declare any convictions or cautions you may have even if they would otherwise be regarded as spent under that Act. The information you give will be treated in confidence and will only be taken into account with relation to appointments where the exemption applies. A police check will be carried out.
Have you ever been convicted of a criminal offence or received a caution or bind-over? If not, write NO, if so, please list all convictions, cautions and bind-overs including any which are spent under the Act. Failure to declare a conviction may disqualify you from appointment or result in summary dismissal if the discrepancy comes to light.
………………………………………………………………………………………………………….
………………………………………………………………………………………………………….
Are you related to any member of the governing body ( any canvassing
Direct or indirect will disqualify)? *Yes/No
If yes, please give details ………………………………………………………………………..
…………………………………………………………………………………………………………..
To the best of my knowledge and belief, the information on this application form is correct.
Signed: …………………………………………………… Date: ……………………………..
You may use the following section to provide any additional information relevant to your application or you may write a letter in support of your application.

R:/Job Pack/Teaching Staff Application Form Feb 17