Monks’ Dyke TeNNYSON College

Application for Non-Teaching / Support Post

Please print in block capitals, using black or blue ink. If you require more space, please submit separate sheets

Application for post:

Grade or Scale:

Section A - General

Name in full (surname first): ______

Previous name(s)/maiden name: ______

Home address: ______

______

Contact address (if different): ______

______

Telephone: ______

E-mail: ______

Date of birth: ______

Section B – Current Employment (if applicable)

Present post: ______

Start date (and end date if applicable) ______

Full/part time: ______

Grade or scale: ______

Name of Employer: ______

Employer’s address: ______

______

Telephone: ______

Type of Organisation: ______

Main Duties: ______

______

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Section C - Education & training

Secondary Education:

Name of Secondary School / College / Dates / Qualifications
From / To / Subject / Level / Date

Further / Higher Education:

Names of Colleges/Universities / Dates / Full or Part time / Qualifications
From / To / Title/Subject / Class/Grade / Date

Other qualifications / relevant training experience:

Name of qualification / training / Dates / Details
Month / Year

Section D - Previous Employment

Please give details of other employment or occupations including HM Forces and present post if applicable together with appropriate date information.

Previous employment including Employer’s name, post held and an outline of your duties / Dates
From / To

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Section G - Criminal offences

Please give details of any conviction for criminal offence(s) or pending criminal charge(s) or cautions in relation to the Sex Offenders Register: Please see declaration below*.

Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(ii) of the Rehabilitations of Offenders Act, 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order, 1975, and you are therefore not entitled to withhold information about convictions which for other purposes are “spent” under the provisions of the Act, and, in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by the Governing Body.

*I confirm I do not have any spent or unspent convictions; pending criminal charges or cautions in relation to the Sex Offenders Register

Signed:

Section H - Medical information

If you are registered disabled, please give your registration number: ______

If you have suffered from any medical condition which has affected (or might in future affect) your performance in this position, please give details:

Please give details of any absence through ill health (longer than three consecutive days) over the past 12 months:

Section I – Referees

Please list two people who will act as referees: (references will be obtained from your present/last employer before an offer of employment is made):

Referee 1: Name: ______

(should be Occupation: ______

current or Address: ______

last employer) and ______

Postcode ______

Telephone Number: ______

Referee 2: Name: ______

Occupation: ______

Address: ______

and ______

Postcode ______

Telephone Number: ______

Section J - Applicant’s statement

To the best of my knowledge I am / am not related to a member of the Governing Body or senior member of staff. (please delete as appropriate) I understand that canvassing, directly or indirectly, will result in disqualification.

Signature of Applicant: Date: ______

Please submit to Ms Heather Morley, Monks’ Dyke Tennyson College, Seaholme Road, Mablethorpe, Lincolnshire LN12 2DF together with a covering letter of application.

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