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Founder and Principal: Mrs.Berry Baker B.A. (Hist.), B.Sc. )Psych.), Dip. BDA Sp.L.D.,P.G.C.E.

Moon Hall School, Pasturewood Road, Holmbury St Mary, Surrey RH5 6LQ Telephone: 01306 731464 Facsimile: 01306 731504

Web address: E-mail:

HEADTEACHER; Mrs Pamela Loré, B.A. Hons.(Psych.), MBPs, M.A. (Ed.), Dip. RSA Sp.L.D.

CONFIDENTIAL

APPLICATION FOR TEACHING POST

This should be returned to The Head Teacher, Moon Hall School (Dorking) together with an up-to-date copy of your C.V.and a letter giving your reasons for applying for and interest in this position and demonstrating, using examples, your suitability for it.

SURNAME MR/MRS/MISS/MS / Date of birth:
FIRST NAMES
PREVIOUS NAMES(if applicable)
ADDRESS
POST CODE
CONTACT TEL. NO’S / Home:
(please indicate if you do not wish to be contacted on any of these numbers) / Work:
Mobile:
Email:
National Insurance Number
DfE Number(if any)
Do you have Qualified Teacher status?
(if so please provide details)
Do you have family or anyone in close relationship with Moon Hall Schools Educational

PRESENT APPOINTMENT

Post held: / Date appointed:
School address: / Employer:
Number on roll: / Responsibility points or allowances (if applicable):
Present salary:
Please give a brief description of your current duties, responsibilities and achievements

EDUCATION AND ACADEMIC QUALIFICATIONS

School/College/University / From / To / Subjects, qualifications, grades, honours and name of awarding body
Primary
Secondary (GCSE and A level)
Higher education or equivalent
Postgraduate qualifications (including PGCE)

PROFESSIONAL DEVELOPMENT Please give details of any professional or vocational training and qualifications that are relevant to your application.

Course title / Provider / Duration / Dates / Awards (if any)

PREVIOUS EMPLOYMENT HISTORY (Please start with most recent)

Title of post and name of school/other employer / Status
(e.g. full time or part time) / Type of school and age range or type of work as appropriate / N.O.R / Period of service
(please include month as well as year)
FromTo

OTHER RELEVANT WORK EXPERIENCE (Please start with most recent)

Nature of occupation / Employer / Period of service
FromTo
If there are any gaps in your education or employment histories please explain them briefly below
IT Skills – please tick column to indicate how you would describe your skills at present
Microsoft Office
Word
Excel
E-mail
Smartboard
Powerpoint
Data bases
Other / Basic / Competent / High

DRIVING LICENCE

Do you hold a current clean driving licence? / YES/NO
How many years have you held it?
During the last five years, have you been involved in any accidents or anything which could affect our insurance? / YES/NO
If yes, please give details:
Are you willing to drive school cars/minibuses if necessary? / YES/NO
Have you had training to drive a minibus?
If so please give date and information about the course.

OTHER TRAINING

Do you have or have you had a First Aid training certificate? If so please provide details.
Do you hold any certificates in relation to health and safety matters?
Do you have any other relevant training certificates?

REFERENCES

Please supply the names and contact details of at least two referees who can comment on your suitability for the position. One should be your current and most recent employer. (If you are not currently working with children your second referee should be the employer by whom you were most recently employed in work with children. References will not be accepted from relatives or persons who only know you as a friend.)

First reference / Second reference
Name
Position
Address
Post Code
Telephone no
Email:
In what capacity known?
If you were known to either of your referees by another name please give details:

REFERENCES

References will only be sought for shortlisted candidates.

May we approach your referees without further reference to you?YES/NO

For persons who are not British or EU nationals

Do you hold a visa that permits you to reside and work in the UK Yes No
If you have conditions related to your employment please give full details
HEALTH
Moon Hall Schools Educational Trust is committed to being an equal opportunities employer and welcomes applications from disabled candidates. The purpose of the following questions is to ensure that the Trust complies with its obligations in particular under the Disability Discrimination Act 1995 as amended (“the Act”). The Act defines disability as a physical or mental impairment which has a substantial and long term adverse effect on a person’s ability to carry out normal day to day activities.

Do you consider yourself to be disabled? Yes No
If Yes, please provide further details

Are there any special arrangements you might require to attend the interview? Yes No
If Yes, please provide further details
If offered the position applied for are there any arrangements or adjustments that the school would need to make to enable you to carry out your role? Yes No
If Yes, please provide details
In accordance with the guidance by the DfE any offer of employment made by the School will be conditional upon the School verifying the successful applicant’s medical fitness for the role. Therefore if your application is successful you will be required to complete a medical certificate of fitness or to answer a medical questionnaire, the responses to which will be checked by the School’s medical adviser before the appointment is confirmed. There may be circumstances when it will be necessary for the School’s medical adviser to seek access to your medical records and/or for you to be referred to a specialist clinician.

INTERESTS (both professional and leisure)

Please give details of any interests, hobbies or skills you could bring to the School for the purposes of the co-curricular activities programme.

CRIMINAL OFFENCES

The position you are applying for involves contact with children and is exempt from the Rehabilitation of Offenders legislation. You are not entitled to withhold information about police cautions, bind-over, or any criminal convictions including any that would otherwise be ‘spent’ under the legislation.

Have you ever been convicted of any offence or bound-over or given a caution?

Yes No

If yes, please give details in a separate letter and enclose it with this Application Form marked ‘Confidential Disclosure’.

If your application is successful you will be required to obtain an enhanced DBS check.

DECLARATION

I declare that the information I have given on this form, and in any correspondence accompanying it, is complete and accurate, that I am not on List 99, disqualified from working with children nor subject to any sanctions or conditions on my employment imposed by the Independent Safeguarding Authority, the Secretary of State or any other regulatory body. I understand that to knowingly give false information, or to omit relevant information, or to fail to complete the form fully and accurately could result in an incorrect assessment of salary, and/or exclusion from short listing, and may, in the event of employment, result in disciplinary action or dismissal at any time or to possible criminal prosecution.
I consent to the School making direct contact with my referees to obtain a reference.
I declare I know of no reasons why I should not be able to discharge the responsibilities required by the position I am applying for and I understand that any offer of employment made by the School is conditional upon verification of medial fitness.
Signature:Date:
All candidates applying by email will be required to sign this declaration if invited to attend an interview.