EAST RIDING SUPPLY SERVICE REGISTRATION2015/2016

Please complete this form and return it to or

East Riding Supply Service, SkirlaughSchool, House, Dorset Avenue, Skirlaugh, HU11 5EB.

Office Use only
Annual Registration Fee / Annual Update completed
Date:
Name:
Teachers: £45.00
Support Staff: £22.00
1. Personal Details
Title: / First Name(s): / Surname:

Male Female / Date of Birth: / National Insurance No.
Address:
Postcode:
Tel. Day: / Tel. Evening: / Mobile:
Email Address:
Emergency Contact (please provide details of someone we can contact in case of emergency):
Name: / Tel. No.: / Relationship to you:
Payment of fees– please choose an option
(Please make cheques to be made payable to East Riding of Yorkshire Council)
1. To pay by cheque, make the cheque payable to East Riding of Yorkshire Council and post with this form to the address on the top of this form. / Cheque No:
______
Amount: / Name of Cheque Account Holder:
______
2. To pay by cash/cheque/debit/credit card go to any Customer Services Centre in the East Riding. / For Customer Service Centre Staff
Cost Code: 351A27Detail Code: 93269 (vat 6)
(Please return this form East Riding Supply Service at the address above)
3. E-mail your return to us and thencall us to pay by debit/credit card / Call 01482 392508 / 01482 392509
9.30am – 4.30pm Monday to Friday
Office Closure from 14 August to 21 August 2015
DBS Update Service
Individuals can subscribe to the service for £13 per year through the Disclosure and Barring Service when they next have a criminal record check. Once an individual has subscribed, any employer or prospective employer can carry out a free, online, instant check to see if any new information has come to light since the individual’s disclosure certificate was issued. Follow the link from our website for further details.

Have you already signed up to the DBS Update Service YES NO (please tick)
Availability from September 2015

Please tick sessions for which you will normally be available:

Enter “C” in sessions where you will be contracted part-time (if applicable):

Monday / Tuesday / Wednesday / Thursday / Friday / Saturday
Morning:
Afternoon:
Evening:
Distance willing to travel inmiles (5, 10, 15, 20, 25, 30, 35, 40, 45, 50)
Are you available at short notice? YES NO Are you available for long term cover? YES NO
Types of Work: All Supply Staff to complete this section.
We offer a complete range of supply staff to schools. Please let us know what roles you want to be registered for
HLTA Teacher Lunchtime Supervisor

Teaching Assistant 1:1 Numeracy & Literacy** Kitchen Assistant

Nursery Nurse: Administrator Caretaker
Instructor 1:1* Cleaner
* 1:1 Instructor (TA/Teacher) attracts pay point STA21 (£10.26/hr)
** 1:1 Numeracy/Literacy (Teacher Status Only) attracts set hourly rate of £25 per hour
Do you wish to be available to Adult Education for appropriate opportunities that arise? Yes No
If yes, what is your subject specialism within Adult Education ______
Primary: / Early Years / KS1 / KS2 lower – Years 3 / 4 / KS2 upper – Years 5 / 6
Primary Subject Specialisms:
Secondary: / Subject / To KS3 / To KS4 / To A Level
Main Subject specialism:
Other Subject specialism:
Do you wish to offer secondary general cover? / Yes / No / Are you an NQT: Yes/No
Date and title of your last ‘Safeguarding Training’ __/__/____ (Please send a copy of your certificate to ERSS)
Pease tell us here any other information about your availability that you think we need to know.

EXPERIENCE AND QUALIFICATIONS

Experience / *√ / Qualifications / *√
1:1 Support external education provision
(1:1 Instructor) / 1:1 Numeracy/Literacy
1:1 Support within a classroom/school / ASDAN
ADHD / Autism Awareness
Aspergers / Basic Food Hygiene
Autism / Braille
Behaviour Management / British Sign Language
Braille / CLAIT
Cash Handling / Counselling
Challenging Behaviour / Degree Qualification (please specify)
Classroom Management / ECDL
Dance/Drama / ESOL
Data Entry / First Aid
Downs Syndrome / Food Hygiene Certificate (please specify)
Dyslexia / Foreign Languages (please specify)
Dyspraxia / GCSE English (grade C or above)
Early Years (children over 12 months) / GCSE Maths (grade C or above)
Emotional Difficulties / HLTA
English as a Second Language / ICT
Excel Spreadsheets / Lifeguard
Excluded Pupils / Lifting and Handling
FMS / Makaton
Foreign Languages / Music (please specify)
General Classroom Support / NNEB
Hearing Impairment / Nursing
ICT / Paediatric First Aid
KS1 / Physical Restraint
KS2 (Lower) / Preschool Practitioner
KS2 (Upper) / PTLS
KS3 / QTS
KS4 / RSA/Processing
Lifeguarding / School Business Management
Marking and Assessment / Sporting Coach
Microsoft Word / TA Level 1
Midday Supervision / TA Level 2
Mixed Year Groups / TA Level 3
Music / TEFL
Personal Care
Physical Difficulties / Other:-
Premises Work
Pupil Referral Units
Reception
Sign Language
SIMS / *It is IMPORTANT that you tick all
Special Schools / Boxes that apply to you. The present
Speech/Language Difficulties / software system allows for better filtering
Sport/PE / when looking for suitable candidates for
Switchboard / bookings. By giving as much information
Visual Impairments / as possible regarding your qualifications,
With children under 12 months / skills and experience it will assist in
Other:- / maximising the opportunities of work
being offered to you in the future.