1

Employment Based Routes

ASSESSMENT ONLY QTSPATHWAY

PRIMARY PHASE TEACHER APPLICATION FORM

This application form must be completed by the teacher applicant. Please complete it carefully.All applicants should submit this form together with:

  • Your supporting school’s Required Information Form
  • Copies of all certificates showing qualifications
  • A copy of your current timetable
  • 2 recent lesson observations of you
  • Confirmation of passing the skills tests in literacy and numeracy
  • Reference/testimonial from the second school. Please note that the Second School Experience must have taken place prior to your application to the Assessment Only Pathway. See website

The information on this form will be stored on a database and is subject to the Data Protection Act. Information may also be made available to Ofsted to enable them to carry out quality inspections of the trainee. The information may also be used by the National College for Teaching and Leadership (NCTL) and used anonymously for statistical analysis.

ORIGINALS OF GCSE AND DEGREE CERTIFICATES AND PROOF OF PASSING THE 2 SKILLS TESTS (IN LITERACY AND NUMERACY) MUST BE AVAILABLE ATINTERVIEW
PART 1
  1. Applicant’s Name and school

Forename(s) / Surname
Employing and supporting school / Address of school
  1. Assessment Only Pathway Information

Year group you are currently teaching
Please Indicate Age Range To Be Assessed In
Ages 3-7
Ages 5-11
Ages 7-11
PART 2
  1. Personal DetailsofApplicant (please write in capital letters)

Title / Mr Mrs Ms Miss Dr
Other (please indicate) ______
Forename / Preferred Forename
Surname / Former Surname
Date of Birth / Gender: / Male
Female
NI Number
Applicant’s Address
(For correspondence )
Postcode
Home Telephone
Mobile
Email Address
Ethnicity
(please tick) / 11. White British / 29. Black Other / 41. Mixed – White and Black Caribbean
12. White Irish / 31. Asian or Asian British Indian / 42. Mixed – White and Black African
13. White Scottish / 32. Asian or Asian British Pakistani / 43. Mixed – White and Asian
14. White Irish Traveller / 33. Asian or Asian British Bangladeshi / 49. Other Mixed Background
19. Other White Background / 34. Chinese / 80. Other Ethnic
21. Black or Black British Caribbean / 39. Asian Other / 90. Do not wish to disclose
22. Black or Black British African / Other
Faith / Belief
(please tick) / 01. Buddhist / 04. Jewish / 07. Any other Faith or Belief
02. Christian / 05. Muslim / 08. No Faith or Belief
03. Hindu / 06. Sikh / 09. Do not wish to disclose
Disability
(please tick) / 00. No Disability / 04. Wheelchair User / Mobility Difficulties / 08. Multiple
Disabilities
01. Dyslexia / 05. Personal Care Support / 09. Other Disabilities not Listed Above
02. Blind / Partially Sighted / 06. Mental Health Difficulties / 10. Autistic Spectrum Disorder
03. Deaf / Hearing Impediment / 07. Unseen Disability (e.g. Asthma, Epilepsy, Diabetes) / 99. Do not wish to disclose
  1. Qualifications

Originals must be shown on theinterview day.
Qualification
(as below or equivalent) / Subject / Institute of Study and Country / Grade / Award Date
(Month & year)
GCSE / Maths
GCSE / English
GCSE / Science
Other GCSEs
A Levels and/or other post 16 qualifications
Degree
SKILLS TEST IN LITERACY* / DATE PASSED
SKILLS TEST IN* NUMERACY / DATE PASSED

*You must have passed the skills tests before sending your application.

Applicants with overseas qualifications
ANARICletter of endorsement must be submitted for all overseas qualifications.
This MUST be attached to this application. Thank you.
  1. Details of any previous programme of Initial Teacher Education in which you have participated

  1. Have you made a previous application to the Assessment Only QTSProgramme?
/ Yes No
If yes, please complete this section:
When did you apply:
What was the outcome of your application?
Did we make any recommendations or conditions? If yes, please detail:
What have you done to address recommendations or conditions made by us?
PART 3: CURRENT SCHOOL: Teaching Experience
Current employing and supporting school:Please note that the AO route is NOT a training route, but for those who are ALREADY meeting the Teachers’ Standards. Your school must endorse your application.
Please indicate the date when you were appointed as an unqualified teacher at your current school
Please state number of years you have taught at your current school (you must have had sole responsibility for the classes you have taught)
Please indicate the year group you are currently teaching and have sole responsibility for, including if it is a mixed year group:
Please indicate any other year groups you have taught at your current school and have had sole responsibility for:
Are you currently teaching the full range of NC subjects? / Yes/No
Please indicate on timetable below
Are you currently Full time or Part time? / If part time, state %
Please indicate your CURRENT timetable below:
Teaching commitment for class/year group where you have sole responsibility.

1

Period 1 / BREAK / Period 2 / LUNCH / Period 3 / Period 4
Monday
Tuesday
Wednesday
Thursday
Friday

1

PART 4: CURRENT AND PREVIOUS SCHOOLS: Other Continuous SchoolExperience
1. Other Continuous School Experience. This includes:Working as an unqualified teacher, working as a teaching assistant, other school-based experience.
School / Role / Amount of time spent teaching per week in school / Date From / Date To
Any additional information or any other responsibilities.
PART 5: SECOND SCHOOL
  • You must indicate details of a second school that will count as your Second School Experience. (Please refer to Second School Experience guidance on the AO webpage). Please note that the Second School Experience must have taken place prior to your application to the Assessment Only Pathway and must be a minimum of 6 weeks in a block.

Name of second school
Address of school
Your mentor whilst at the school
Your role within the school
Full-time or Part-time
Type of School & number on the role
When was the school’s last Ofsted inspection and what was the outcome?
Is the school in partnership with CCCU?
Dates spent teaching at school
Year groups taught
Have you evidence of planning, teaching and assessing your classes? ***
Have you evidence of being observed at least 6 times teaching in this second school? ***
Have you got a reference or testimonial from the second school? ***
*** Please note that if selected for interview you will need to bring examples to show the interviewer
Any Additional Information:
PART 6: SATISFYING AGE PHASE REQUIREMENTS
Have you evidence of planning, teaching and assessing classes across the age phase in which you intend to qualify? This means either FS and KS1, or KS1 and KS2. ***
Have you evidence of being observed teaching across the age phase in which you intend to qualify? This means either FS and KS1, or KS1 and KS2. ***
*** Please note that if selected for interview you will need to bring examples to show the interviewer
PART 7: PREVIOUS OCCUPATIONS OTHER THAN TEACHING
Please give brief details, referring to any skills relevant to education.
PART 8: PERSONAL STATEMENT
Please include here;
  • references to organisational and leadership skills
  • evidence of subject knowledge
  • evidence of ability to meet the Teachers’ Standards
  • full details of experience in education
  • full details of current timetable and independent teaching commitment
  • the names of two referees to whom we can apply forconfirmation that you meet the requirements for this Pathway. One of these referees should be in the second school (where applicable).

Declarations
  1. I agree that the information on this application and any agreed action plan may be made available to University assessors as appropriate to enable them to assess me in relation to the Teachers’ Standards.

  1. Self Declaration – Safeguarding (Requirement A1.3)
I have no convictions, which would deem me unsuitable for working with children (all applicants will need a Disclosure and Barring Service check DBS by the school and the university before registration onto the AO Pathway can be confirmed.)
  1. My DBS number is:

  1. Self Declaration – Health and Physical Capacity to Teach (Requirement A1.3)
I believe that I have the health and physical capacity to teach. Please note applicants who have a disability will be supported in their application and are encouraged to discuss any additional needs arising from this disability, which should be taking into account with this application.
  1. I agree that the information on this application and any agreed training plan may be made available to Ofsted to enable them to carry out their quality assurance role in teacher training.

  1. I do not already have UK Qualified Teacher Status.

  1. I CONFIRM that the originals of these certificates will be available to the University for scrutiny at interview stage and prior to the commencement of the Pathway. They should also be available at the University Initial Meeting prior to the start of the Pathway.

Signature ______Date ______
Print Name ______

Once completed applicants should send this application form together with all other documents outlined at the beginning of the application form to Admissions, Canterbury Christ Church University, North Holmes Campus, Canterbury, Kent. CT1 1QU.