Application Form – Confidential

Please use TYPE or BLACK ink and complete ALL sections

APPLICATION FOR THE POST OF: LADDER SCHOOL PRINCIPAL DESIGNATE
CLOSING DATE: Wednesday 31st January 2018, 6pm
Your application should be returned to : or post FAO: HR Recruitment, The Ladder School C/O Walsall Studio School, Goldmine centre, 14a Lower Hall Lane, Walsall, WS1 1RL

Section A – Personal Details

Title (Mr, Mrs, Miss, Ms or other) :
Surname: / Forename:
Address
Postcode
Daytime Telephone / Mobile Telephone
National Insurance No / e-mail address:
DfE Teacher Ref No :
If you are not a European Citizen, please state if you require a work permit / Yes No
Do you hold a current driving licence? / Yes No
Are you registered with the Teaching Agency at the DfE (previously the GTC) / Yes No

Section B – Employment Record

Name and address of current employer / Name and address of establishment where employed (if different):
Post title: / Full Time / Part Time / Fractional :
Part Time Hrs ______
Date appointed: / Age Range:
Current annual salary:
£ / Point on pay spine: / Additional TLR payment (if appropriate):
£
Brief description of present duties
Reason for wishing to leave current employment:
For Senior Management posts only:
Is your current school/academy designated by Ofsted as requiring Special Measures or having Serious Weaknesses?
Yes _____ No _____
Previous employment
Name & Address of Employer: / Dates of Service / Job Title & Major Elements of Job / Reason for leaving

Section C – Education / Professional Qualifications

Dates / Full or Part Time / Name of Educational Establishment / Qualification gained / Class of Degree (2:1 Hons etc.) / Date of Award
From / To
Details of Teacher Training:
If qualified since 1999 please give date when NQT status awarded:
For newly qualified teachers only – please confirm current status of Induction Period including dates/outcomes of reviews:
1st Review: / 2nd Review: / 3rd Review:

Section D - Disability / Health

Walsall Studio School is committed to providing access to employment opportunities for disabled people. To assist us in carrying out this policy please provide any relevant information which has a substantial and long term adverse effect on your ability to carry out day to day activities. This information will be treated as confidential and will only be used to enable selectors to make a fair assessment of your capabilities, taking into account any adjustments that may be required.
Do you consider you have any medical condition or disability which may be covered by the provisions of the Disability Discrimination Act (1995)?
Please tick: Yes ______No _____
If you have answered Yes to the above, please answer the following questions:
1.  Is there any information that we need in order to offer you a fair selection interview?
2.  Is your health such that you can carry out the prescribed activities of a teacher as set out by the Education Act 2002?
3.  Have you the resilience and stamina to fulfil the requirements of the role for which you are applying?
The appointed candidate will be required to complete a Health Questionnaire and may be required to undergo a medical examination.

Section E - Equal Opportunity and Employment

Walsall Studio School is committed to equal opportunities for all, irrespective of race, colour, creed, ethnic or national origins, gender, marital status, disability, religion or belief, sexual orientation or age.

To ensure this policy is carried out effectively, we ask all applicants to provide the information requested on this page. It will be used only for administrative and monitoring purposes and will be confidential and not used to discriminate in favour or against any individual applicant.

Please Note: The categories below have been recommended to the employers by the Commission for Racial Equality and are being collected to assist the Council to monitor the effects of its equal rights policy and to meet the requirements of the Race Relations (Amendment) Act 2000.

Ethnic classification:

White / English
Scottish
Welsh
Irish
Any other white / 1
2
3
4
5
Mixed / White & Black Caribbean
White & Black African
White & Asian
Any other mixed / 6
7
8
9
Asian or Asian British / Indian
Pakistani
Bangladeshi
Kashmiri
Any other Asian / 10
11
12
13
14

Ethnic classification (cont.)

Black or Black British / Caribbean
African
Any other black / 15
16
17
Other Ethnic Groups / Chinese
Any other ethnic group / 18
19

Section F – Safer Recruitment and Disclosure of Criminal Background

The Mercian Trust is committed to protecting the welfare of vulnerable groups through safe recruitment and selection processes. As part of the interview process shortlisted candidates will be asked to disclose any criminal background.

Prior to starting work at Walsall Studio School successful candidates must complete an enhanced DBS disclosure and other statutory checks. Failure to do this will result in offers of employment being withdrawn without further consideration.

Section G – Data Protection Act

The personal information collected on this form will be processed on computer to manage your application. If successful, your personal information will be retained whilst you are an employee and used for payroll, pension and personnel administration. It will not ordinarily be disclosed to anyone outside the Academy without first seeking your permission. You can ask our Data Protection Officer about your legal rights regarding personal information or you can contact the Information Commissioner whose website is www.informationcommissioner.gov.uk

Section H Reference

It is our policy to take up references for shortlisted candidates where the timescale permits. Any job offer will be conditional upon completion of all safer recruitment checks and suitable references approved by the Trust.

Please give names and addresses of two referees, one of which must be your present or most recent employer. If you have not previously been employed, give the name of someone who knows you well. Referees should have direct knowledge of your professional capacities and performance.

Name of Referee:
Tel:
e-mail: / Status or job: / Address for contact
Postcode:
Name of Referee:
Tel:
e-mail: / Status or job: / Address for contact
Postcode:

May we approach your present employer before the interview? Yes o No o

Section I Declaration

You are required to declare below any relationship with or to any member of staff employed by the Mercian Trust, Queen Mary’s Foundation or The Vine Trust.

Please state name and position:

What is your relationship to the person named?

Have you ever been the subject of formal disciplinary proceedings?

Yes o No o

If you return your application form to us by e-mail and you are subsequently invited to interview, you will be required to sign a printed copy of your form.

I declare that the information on this form is correct to the best of my knowledge and I note that the withholding, falsification or omission of relevant information by a successful candidate are grounds for disciplinary action which may lead to dismissal.

I confirm that I have a legal right to work in the UK and if this application is successful, I undertake to produce appropriate documentary evidence to prove this, prior to commencing work with the Studio School.

Signed: Date:

You should clearly write the word “application” on the outside of the envelope.

The planned dates for assessment and interview for this post are available on our website.
If you have not received a reply from us by Wednesday 7th February you should assume your application has not been successful at this time.

Supporting Statement (Page 1 of 2):

Please state why you are applying for this post and explain briefly how your experience to date has prepared you for this new role. Where possible please support your statement with examples and evaluation of the impact your work has had in your current / previous employment as well as any community or third sector involvement you may have.

Please note this statement should address the job description and person specification for this role. In particular, you are reminded to give consideration to the shortlist criteria highlighted.

You statement should be no more than two sides of A4.