Telephone 020 8531 3426 Fax 020 8527 3613 Email Principal Elaine M Colquhoun Med, BA

Macdonald Road

Walthamstow

London E17 4AZ

Telephone 020 8531 3426 Fax 020 8527 3613 Email Principal Elaine M Colquhoun Med, BA

TEACHER APPLICATION CONFIDENTIAL

APPLICATION FOR APPOINTMENT AS:

PERSONAL DETAILS(Block letters in black ink or typescript please)
Last Name and Title: / First Name(s):
Former Names: / Date of Birth:
Home Address:
Post Code:
Telephone Number:
Mobile Number: / Email Address:
National Insurance Number:
DfES Number:
GTC Registration Date:
Date Qualified Teacher Status obtained:
Do you require a Certificate of Sponsorship? Yes/No
Visa Expiry Date:
*Statutory Induction completed?
or number of completed terms. / Yes/No / Dates / Place/LEA
Term 1: / Dates / Place/LEA
Term 2: / Dates / Place/LEA
Term 3: / Dates / Place/LEA
PRESENT POST (or most recent employment)
Establishment:
(Please indicate status of school)** / Group Size of School: Number on roll:
Post Held: / Salary Spine:
Salary Point:
Number of Management Allowances:
Date of Appointment:
Address:
Telephone Number: / Duties and Ages taught:
Date Left/Period of Notice:
PREVIOUS TEACHING EXPERIENCE(in chronological order).
Name/Type of School
(Please indicate status of school)** / Dates
From/To / Post held and Scale / Number on Roll / Ages
Taught / Subjects
* For teachers qualified as from Summer 1999
** Community, Foundation, Voluntary Controlled, Voluntary Aided, Independent or Private

HIGHER EDUCATION

Place of Study / Dates / Main Subjects / Subsidiary
Subject(s) / Qualification gained
Degree, Cert, Diploma, etc
(including class)

SECONDARY AND FURTHER EDUCATION WITH EXAMINATION RESULTS

SUBJECTS PASSED WITH GRADES (e.g. O/A Level/GCSE/GNVQ).
School or College attended:
Subjects Taken / Examinations Passed / Grades / Dates
OTHER COURSES ATTENDED IN THE LAST FIVE YEARS
Course Details / Dates / Course Details / Dates

OTHER EMPLOYMENT/VOLUNTARY WORK

Name of Employer(s) / Details and nature of work / Inclusive period of Service
From To / F/T or P/T
HEALTH
How many periods of sickness absence have you had over the past 2 years?
How many working days has this amounted to in total?
Have you been granted Infirmity Retirement by the Department for Education and Skills?
YES/NO If YES please give the date: …………………………
HAVE YOU AT ANY TIME BEEN DEBARRED FROM TEACHING?
YES/NO (If YES, please enclose details with dates in a sealed envelope and attach to this form)

YOUR SUPPORTING STATEMENT

You are requested to set out on a separate sheet(s) relevant information in support of your application. This should demonstrate how your past education and experience has helped you prepare for a teaching post at Whitefield.

LEISURE ACTIVITIES AND INTERESTS

Please give brief details of your recreational and any other special interests that you consider may be relevant to this post.

REFERENCES

It is expected that Teachers/Deputy Headteachers will name their present or most recent Headteacher as their first referee. Headteachers should list their Local Education Authority or Employing Body (if employed at an Independent or FoundationSchool). University leavers should name their course tutor. Both referees will be contacted before interview, unless you ask us in writing to wait with one of them.
Note: If you were known to any of your referees by a different name, please include details.
Name
Position
Address / Name
Position
Address
Tel No: / Tel No:
Fax No: / Fax No:

CANVASSING

Do you have a personal relationship with anybody in a position to influence how your application is treated? YES/NO (if YES, please give details)

DISABILITY

Please describe any disability or condition which we may need to consider in assisting you to fulfil the duties of this post.
Are there any arrangements we can make for you if you are invited for interview? Please specify, e.g. Parking space, ground floor venue etc.
The above information is to help us to fulfil responsibilities under the Disability Discrimination Act and assist in the employment of people with disabilities.
EQUAL OPPORTUNITIES/ETHNIC MINORITIES
WhitefieldSchools and Centre is an equal opportunities employer that seeks to attract people of both genders and diverse ethnic origins. How would you describe yourself?
Gender: …………………
(Male/Female)
Ethnic Origin: ………………………………………………..
For example: Black – Caribbean etc
Asian – Pakistani etc
White – Australian etc
DISCLOSURE OF CRIMINAL CONVICTIONS (please read the enclosed Employment of ex-Offenders Policy)
WHERE DID YOU SEE THIS POST ADVERTISED?
Name of Publication(s): …………………………………………………………………

CERTIFICATION

I certify that to the best of my belief, the information I have provided is true, and I understand that any false information or failure to disclose any criminal convictions will result, in the event of employment, in disciplinary investigation by the Governing Body of the School, and is likely to result in dismissal.
Signed:…………………………………………………………… Date: ………………………………………..