Completing This Form Secures You As a Teach Again Programme Applicant

APPLICANT PERSONAL INFORMATION FORM

CONFIDENTIAL

Completing this form secures you as a Teach Again programme applicant. For further information please visit telephone 07904 085182 or email information on fees, please visit teach-again-programme-costs.

Please note that in order to fully complete your registration and undertake a programme with us, you will also be required to agreeto our terms and conditions and make a payment. Details will be provided on receipt of this completed application form.

This form, and Compliance Checklist documentation, will be shared with your placement school. Do therefore complete it fully.

PERSONAL DETAILS

Title / Contact Details
First Name / Full postal address
Surname
Any other name if used in preference
Gender / Postcode
Nationality / Tel No. / Home
NI number / Mobile
Date of Birth / Work
Do you have a full UK driving licence? / Fax
Are you a UK citizen? / Email:
If not, please confirm your status of right to work in the UK (see note) / Teacher ref no.
Do you have qualified teacher status (QTS)?
Note: If you trained and qualified overseas in a country outside of the European Economic Area (EEA) or Switzerland (not including Canada, Australia, New Zealand and the United States of America) you may teach in state maintained schools and non -maintained special schools in England as unqualified teachers for four calendar years but you must apply for and obtain QTS during that period if you wish to teach in England after that period.
Why do you want to return to teaching/teach in the UK?
Please indicate what teaching experience you require. If you require additional experience e.g. an additional subject, SEN, managerial, pastoral please state here: / Primary KS1
Primary KS2
11-16 Subject(s)
Post 16 Subject(s)
How many days per week would you like to access the TA programme that you require? (minimum is two days)
How far are you willing to travel to your placement school/academy/college?
What notice do you have to provide and when would you be looking to start the Teach Again programme? / Notice required / Start date
Are you registered with any teacher supply agencies? / If yes, please name each agency here:
Yes / No
How did you find about the Teach Again Programme?
If you were referred by an agency please name the agency here.

TEACHING AND PROFESSIONAL QUALIFICATIONS GAINED

Dates / Name of Educational Establishment / Qualification gained – include class of degree, PGCE, CertEd TDLB, and professional agencies e.g. CMI etc / Date of Award
From / To

PREVIOUS EMPLOYMENT IN AN EDUCATION ENVIRONMENT

Starting with the most recent first giving exact dates – Please continue on a separate sheet if necessary

Employer
(if employed by an LEA give LEA and school/college) / Post / Grade/Scale / Full or part time (if part time please give hours) / Dates
From / To
Month / Year / Month / Year
What was your reason for leaving teaching?

SAFEGUARDING

Do you have any unspent convictions? If Yes, please detail.
Date of your DBS Check
DBS Number
Level of DBS check (standard / Enhanced)
Are you registered with the DBS update service?
Are you prohibited from teaching?

PERSONAL DECLARATION/DISCLOSURE

Do you currently have any medical condition which may impact upon your ability to fulfil any programme you may be offered or which may present health and safety issues in the workplace? If Yes, please provide detail.
Do you consider yourself disabled under the Disability Discrimination Act? If yes, please advise of any special requirements.

KEY ACHIEVEMENTS, SKILLS AND STRENGHTS

If you wish, you may provide details of key achievements/ successes/ career highlights here
Disqualification under the Childcare Act 2006
Staff who are directly concerned in the direct delivery or management of early or later years provision are covered by this legislation. As an introductory agency, we are required to ask you if you believe you may be disqualified ‘by association’ under regulation 9 of the 2009 Regulations. An individual is disqualified ‘by association’ where they live in the same household as a disqualified person or in a household in which a disqualified person is employed. If you require details on cautions and convictions that would disqualify an individual from working with children, you should look at the relevant regulations within the Rehabilitation of Offenders Act (RHO).
It is an offence to declare that you are not disqualified by association when you are disqualified under the 2009 Regulations.
Further information on waiver from disqualification can be obtained here:
Waiver Disqualification information
Declaration:
I confirm that I am not disqualified under section 75 of the Childcare Act and Section 76(2) of the 2006 Act.
Print name: ______

EDUCATIONAL REFERENCE

Please provide if possible an education referee, who should be a manager from an educational setting you have worked in.If you are unable, please provide two peer/character referees. All referees will be contacted prior to programme placement.

1st Referee
Name / Postal Address
Position
Organisation
Email
Phone Number / Postcode
2nd Referee
Name / Postal Address
Position
Organisation
Email
Phone Number / Postcode

PEER or CHARACTER REFERENCE

A Peer Reference is a positive testimonial from a colleague who has worked at the same level as you, who understands your day to day job more in depth than your manager. They can provide more insight and detail into the service and knowledge you deliver daily. This can be from an education setting or from an employer who is not education related.

1st Peer Referee
Name / Postal Address
Position
Organisation
Email
Phone Number / Postcode
Can we contact the above referee?
2nd Peer Referee
Name / Postal Address
Position
Organisation
Email
Phone Number / Postcode
Can we contact the above referee?

Please sign below to confirm that the above information provided is correct.

Signature Date ______

Thank you for completing and submitting this form. Teach Again Ltd will be in touch to further progress your application to commence a Teach Again programme.

______

Teach Again use only

Compliance checklist

The following documentation must be presented to Teach Again Ltd in order to be placed on a programme. Applicant note: For your security, please do not email us these documents. They will all be checked in person when we meet with you for your Identity Check – thank you.

Document / Check
Current Enhanced DBS certificate
Photo identification – passport or driving licence
Proof of Address – utility bill (bank statement alone will not suffice)
Certificates of education and training to include teaching qualification(s), maths, English, and Science if for Primary.

Teach Again use only:

I confirm that I have seen and am satisfied with the documentation that has been presented to me as listed under the Compliance Checklist:

Signed ______

Dated ______

Countries within the Economic Area

EU countries. The EU countries are: Austria, Belgium, Bulgaria, Croatia, Republic of Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and the UK.

Teach Again

Helping Teachers Return to Teaching across the UK

Tel 07904 085182