Queen Ethelburga’s Collegiate Foundation
Thorpe Underwood Estate
Thorpe Underwood
York
YO26 9SS
Please complete this summary form in addition to providing full Curriculum Vitae
POSITION APPLIED FOR1. PERSONAL INFORMATION
Forenames
Date of Birth
National Insurance No / SurnameFormer Name
(If applicable)
Marital Status
DFES No
DFES No
Address /
Tel. No.
E Mail Address
______Current Salary
Do you have a full driving licence? /
Do you own your own transport?
2. EMPLOYMENT INFORMATIONPresent
Position /Date of
AppointmentEmployer’s
NameAnd Address
Summary of
ResponsibilitiesAnd
Experience
3. QUALIFICATIONS: Do you have QTS? Yes/No
Higher Education
Qualifications(with grades, dates & institution)
Post-
GraduateQualifications
(with dates & institution)
Specialist
courses
attended
in the last 5 years
ICT knowledge / Please circle the options that best apply to you.
Prepared to lead ICT staff INSET / Regularly use IT in lessons / Occasionally use IT in .lessons / Rarely use IT in lessons / Confident user of IT for admin / Nervous user of IT for admin
Hobbies and interests
4. EMPLOYMENT HISTORY
Teaching
Dates /School
/Position Held
Non-Teaching
Dates / School / Position Held5. EXAM RESULTS RECORD
Please fill in the boxes below for all exam groups for which you were responsible
A level (Last 3 years) / 20__ / 20__ / 20__
Number of candidates starting the course
Number of candidates finishing the courseNumber of A* grades
Number of A grades
Number of B grades
Number of C grades
Number of D grades
Number of E grades
GCSE (Last 3 years)
Number of candidates starting the course
Number of candidates finishing the course
Number of A* grades
Number of A grades
Number of B grades
Number of C grades
Number of D grades
Number of grades below D
BTEC (Last 3 years)
Number of candidates starting the course
Number of candidates finishing the course
Number of D* grades
Number of M grades
Number of P grades
Key Stage Sats. Please provide the % of each grade
Key Stage 1
Key Stage 2
Teaching subjects
Please list all subjects you are qualified to teach and to what level
Subject / Level / Qualifications / Experience
6. medical /safeguarding history
Please note that the successful applicant will be required to complete a questionnaire for consideration by an appointed Medical Officer in order to satisfy the Education (Health Standards) (England) 2003. QE will fully comply with its duties under the Disability Discrimination Act.
7. References
Name / Name
Address / Address
Phone number / Phone number
Email address / Email address
May we contact prior to interview / Yes { } No { } / May we contact prior to interview / Yes { } No { }
This post is exempt from the Rehabilitation of Offenders Act 1974 and all convictions, cautions and bind-overs, including those regarded as ‘spent’, must be declared. We require a signed statement that you are not on List 99, disqualified from working with children, or subject to sanctions imposed by a regulatory body, e.g. the General Teaching Council (GTC). You must also inform us if you ever had a concern raised about your behaviour towards a child or children? You must either have no convictions, cautions, or bind-overs, or have attached details of your record in a sealed envelope marked confidential.
Signed… …………………………………………………. Date………………………..