Clerking Fund – Funding Release Form

Name of School
Name of Headteacher
Name of Chair of Governors
Name of Clerk to Governors

Declaration of intent - Chair of governors and headteacher

I confirm that the above named chair of governors and headteacher have discussed and reached agreement to work to the Clerking Service Protocol (‘the protocol’) and adhere to the funding eligibility criteria detailed within ‘the Protocol’ and associated document - ‘the Service Protocol - Supporting Information’. / Yes /No

Declaration of intent - Clerk to governors

I confirm that the above named chair of governors and clerk to governors have discussed and reached agreement to work to the Clerking Service Protocol (‘the protocol’) and adhere to the funding eligibility criteria detailed within ‘the Protocol’ and associated document - ‘the Service Protocol - Supporting Information’. / Yes /No

Clerks Accreditation Scheme – Level 3

I confirm the above named clerk currently holds or is working towards Clerks Accreditation Scheme (Level 3) or equivalent. / Yes/ No
or
I confirm that the above named clerk has agreed to undertake Clerks Accreditation Scheme (level 3) or equivalent. / Yes / No

Newly appointed clerks – probationary appraisal and personal development plan

I confirm the above named clerk is newly appointed to the Clerk to governors job description and that a Standards Appraisal Checklist 3 will be completed during his/her probationary year to identify any training and development needs.Please refer to ‘Guidance – Completing a clerk appraisal’ / Yes / No or Not applicable
Employment start date / / /
Contracted Hours

Existing clerks

I confirm the above named clerk’s current employment
status as: / Current contracted hours
Current Grade
Current scale point

Existing Clerks

Appraisal and Personal Development Plan

Please refer to ‘Guidance –Completing a clerk appraisal’

I confirm that a Standards Appraisal Checklist 3 has been completed with the above named clerk and a copy of the Personal Development Plan is attached. / Yes /No or Not applicable

Performance score following appraisal

The grade and scale point at which payment will be calculated is dependent on the overall performance score of the above named clerk. Please refer to ‘Guidance – Calculating a clerk’s grade and scale point’.For new clerks please complete grade and scale point only

Evidence of Performance / RED / AMBER / GREEN
Number of indicators ticked (A)
Weighting Rate (B) / N/A / 2 / 1
Sub-total score (A X B) / N/A
Sum of Amber + Green sub-totals
RED Indicators - If any Red indicators are marked add 40
Overall performance score

Changing an existing clerk’s pay and conditions

Any changes to the clerk’s pay and conditions need to be put on the school’s Personnel Return

New grade and scale point(Complete for new and existing clerks)

I confirm the above named clerk should be contracted on Grade 7, Scale point

East Sussex County Council Pension Scheme

I confirm the above named clerk contributes to the ESCC pension scheme. / Yes / No

Level of funding requested

Number of clerking hours to be funded (maximum 120hours)
Training and development hours to be funded (minimum 10 hours)
Total hours to be funded (maximum 130 hours)

Declaration

I confirm the information provided is complete and is an accurate reflection of the commitment of chair of governors, headteacher and clerk to governors to work to the protocol.

Signed / Chair of Governors
Print / Date
East Sussex Clerking Service – Clerking Fund – Funding release form v5
Date modified: January 2018 / 1