Upper-schoolsite:StanleyAvenue

Wembley,MiddlesexHA04JE

Lower-schoolsite: EalingRoad

Wembley,MiddlesexHA04PW

Tel: 020 8902 2038Fax:020 89001236

Email:

Headteacher:Mr GerrardMcKennaBsc(Hons)NPQH

APPLICATIONFOR ATEACHING APPOINTMENT

Job Title

SecondarySubject

Where did you see this post advertised?

Pleasereturnformto:

When could youtakeupdutiesif appointed?

Pleasereadall instructionscarefullybeforecompleting thisform.Pleasecomplete infullintype orblackink. We areunabletoacknowledgeapplications.Ifyouhavenotbeencontacted withinfour weeksoftheclosingdate you canassumethat yourapplicationhasnotbeensuccessful.

PartA –PersonalDetails
Title / FirstName
Surname
Address
Postcode
Address
(for correspondenceif differentfromabove)
Postcode
Telephone / Day / Evening / Mobile
Email
If applicable, do you need a work permit to work in this country? Yes No 
If youhaveaworkpermit, pleasestateif thereareanylimitations/conditions/ expiry dateonthework permit.
National InsuranceNo.
Pleaseindicateifyouhavea disabilityyouwantthe schooltotakeintoaccount. YesNo
Pleaseoutlinewhat assistance(if any)youneedduringtherecruitment andselectionprocess e.g. asigner.
DateofrecognitionasqualifiedteacherbytheDfE
DfENo.
GTCNo.
Haveyousuccessfullycompletedaperiodof induction/probation?YesNo

If yes,withwhichauthority?

Dateofcompletionof induction/probation?

PartB–Education and training–1.SecondaryEducation
Detailsofsecondary/further education.Pleaselistallschools,colleges,etc.which you haveattended.
Nameofestablishment
(school,college,etc.) / Qualification gained &Subject / Grade / Dates
From / To

Pleasecontinueon a separatesheetifnecessary.Youwill beaskedto provideoriginal proofof relevant qualificationsifyou areinterviewed.

PartB–Education and training–2.HigherEducation/TeachingQualifications
Detailsofhigher education/teaching qualifications.Pleaselistall colleges,universitiesetc. whichyouhave
attended.
Nameofestablishment
(school,university,etc.) / Qualification gained &Subject / Grade/ Class / Dates
From / To
PartB–Education and training–3.HigherEducation/TeachingQualifications
Nameof professional body / Wasmembership gained by
examination / Membership
grade / Date
PartB–Education and training–4.RelevantIn-Service Courses
Detailsofall relevantin-servicecoursesattended.
Course / Qualificationsgained
(if applicable) / Dates
PartC–1.Presentormostrecentemployment
Nameand
address of employer
Postcode
Tel. no. / Fax. No.
Postheld
Datestarted / Until
BasicSalary / Other
Allowances / Total
Remuneration
Keyroles/achievements:
1.
2.
3.
Reason forleaving
PartC–2. Full employmenthistory(most recentfirst)
Nameand fulladdressof employer
(including telephone no.) / Dateof employment / 1. Position
2. Salary / Reason forleaving
From
DD.MM.YY / To
DD.MM.YY
Tel. / 1.
2.
Tel. / 1.
2.
Tel. / 1.
2.
Tel. / 1.
2.
Tel. / 1.
2.
Tel. / 1.
2.

Pleasecontinueon a separatesheetifnecessary.

Haveyouever been dismissed byanemployer?YesNo

Details

PartD–Experience/RelevantSkills/FurtherInformation

Usethissectiontoshowhowyoumeetalloftheshortlisting criteria for thejob assetoutin theperson specification,drawingon all aspectsofyour education,training and experience,including paid or unpaid employment,voluntarywork,and homeresponsibilities.

Shortlistingwill beconducted onlyon the basisof written applications. Itisthereforeessentialthatall applicants, both internaland external,should completethissection of theapplication form.

Pleasecontinueon a separatesheetifnecessary.

PartE–Verification of Employment
Pleasegivenamesand addressesoftwopeoplewhocan provideemploymentreferences.Onerefereeshould
normallybe your currentheadteacher.
Referee1 / Referee2
Name / Name
Position held / Position
Address / Address
Postcode / Postcode
Tel. No. / Tel. No.
Fax. No. / Fax. No.
Email / Email
Pleasetickthis boxifyoudonotwishtheschool toapproach your presentemployer until,and if,a firmoffer of employment hasbeenmade. Theschool normallytakesup referencesifyou havebeenshortlisted.Pleasenote thatwereservetherighttoapproach anyofyour previous employersfor referencesif necessary.

CriminalConvictions

Bylaw,spentconvictionsmustbedisclosed.Wouldyou pleasegivedetailsof anycriminal convictions

(notincluding minortrafficoffences),if you havenoconvictionspleasewrite‘NONE’.

Declaration
I herebydeclarethatIhave understood and compliedwith therequirementslaiddown in thepreviousparagraph
and I agreethattheinformation givenon thisform maybeused for registered purposesundertheDataProtection Act,1984. Ihavealsounderstood and complied with theprovisionsconcerning thedisclosureor criminal convictions.
Failureto discloseinformation orproviding deliberatefalseinformationtosupportyour applicationor canvassing, directlyor indirectly,anyonelikelytobeinvolved in theappointment processwilldisqualifyyou fromappointment or if appointedwill renderyou liabletodismissalwithoutnotice.
Name
Signature / Date

ADDITIONALDECLARATIONOFINFORMATION

CONFIDENTIAL

Tobecompleted byall applicants. Pleasecompleteintype or blackink.

PersonalDetails

A checkonthepossibleexistenceand contentof acriminal recordwill normally berequested fromtheCriminal RecordsBureau aftera person hasbeen selected for appointmenttothispost. Refusal toagreetoa checkbeing madecould disqualify you from being considered for theappointment.

You arethereforeaskedtosign thestatementonthisdocumenttoconfirmyouragreement,ifyou areselected for theappointment,toacheckbeingmadeon anycriminal record applicabletoyou.

UndertheRehabilitationofOffendersAct1974,you havetherightnotto disclosedetailsof'spent' convictions. However,becausewearea school andyouwill beworking in an environmentwith children and young peoplewe areallowedtoaskabouttheseoffences. TheRehabilitationof OffendersAct1974(Exceptions)Order1975(as amended)setsoutdetailsof all jobstowhich thisappliesand thejobyou haveapplied for isincluded in thatlist.

Please givedetailsof ALL convictions,cautions,bindovers, reprimands, orwarnings

(whetherspentornot).

CriminalRecordsBureau

TheCriminal RecordsBureau is an executiveagency of theHomeOfficeand helpsemployers checkrecordswhichwere previouslyheld bythepolice,the Departmentof Health and the Departmentfor Children,Schoolsand Families.Differentlevelsof disclosurecanbeprovided, according tothetypeof workapplied for.

Thejob forwhichyouhaveapplied will necessitateanEnhanced Disclosure. Thesearefor positionswitha greater degreeof contactwith children orcertain vulnerableadults,likesocial workersandteachers,for example.Theycontain alltheinformation givenon a Standard Disclosureplusrelevantnon-conviction information held atlocal levels.

Haveyouever been subjecttoanysortof investigation byan employer? YesNo

If you haveanswered 'yes'tothisquestion,pleasegivedetailson aseparatesheet.

Pleasesupplydetailsof activitiesinvolving contactwith children and vulnerableadults outsidethe
workenvironment(e.g. sportscoach,scoutleader,etc.). Pleasecontinueon aseparatesheetif necessary.
Declaration
I agree,ifI amselected forthisappointment,toan application beingmadetotheDisclosure and Barring Service (DBS)for anEnhanced Disclosureconcerning myself.
I alsoconsenttoACScarrying outotherappropriatecheckswith theDBS if itsowishes.
Name (pleaseprint)
Signature / Date