CONFIDENTIAL

LONDONDIOCESAN BOARD FOR SCHOOLS TEACHING STAFF APPLICATION

(includingHeadsandLeadershipposts)

APPLICATIONFORMFOR
(Post)
at Princess Frederica CE VA Primary School VoluntaryAided
(NameofSchool)
ChurchofEnglandSchoolin Brent LocalAuthority
PartA–1. APPLICANT’SPERSONALDETAILS
SURNAME: / TITLE(Mr,Mrs,Msetc.)
FORENAMES: / PREVIOUSNAME(S)(if applicable):
PERMANENTADDRESS:
TEMPORARYADDRESS:
WORKTELEPHONE: / HOMETELEPHONE: / MOBILENUMBER:
EMAIL:
DoyouholdQTS?Yes No
Dateawarded: / TeacherReferenceNumber:
ArethereanyrestrictionsonyourbeingresidentorbeingemployedintheUK?
Yes No

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2.EDUCATIONANDTRAINING
NAMEOFINSTITUTEANDADDRESS / FROM / TO / EXAMINATIONSPASSEDWITHGRADES
SecondarySchoolorCollege: / GCSEorequivalent:
ALevelsorequivalent:
UniversityorCollege: / Mainsubject(s):
Degreeanddateawarded:
Classofdegree: Full time/Parttime:
PGCEInstituteattended: / Dateawarded:
PostGraduateStudy: / Qualification:
Dateawarded:
NPQH / Dateawarded:

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3.INSERVICETRAINING/PROFESSIONALDEVELOPMENT
LONGCOURSESOVER3DAYSATTENDEDINTHELAST3YEARS
TITLE / ORGANISINGBODY / FROM / TO
SHORTCOURSES(1-2days)ATTENDEDINTHELAST2YEARS
TITLE / ORGANISINGBODY / FROM / TO

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4.EMPLOYMENTRECORD(Pleaselistcurrentemploymentfirst.Includeallareasofresponsibilitywithdates)
Nameandaddressofschoolor academy / LocalAuthority / Number onroll / Agerange ofschool / JobTitleand scale / Full/ Part
Time / Dates
From / To

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5.EMPLOYMENTOTHERTHANTEACHING
NAMEOFORGANISATION / JOBTITLE / FROM / TO
6.CURRENTSALARY
BASICANNUALSALARY(pleaseindicatespinepoint):
ADDITIONS(pleasegiveallowances,TLRs,Londonweightingetc.):
TOTALSALARY:
7.PROFESSIONALREFERENCES
Pleasegivethenamesoftworefereeswhocanvouchforyourprofessionalwork,oneofwhomshouldbeyour presentHeadteacher.CandidatesforHeadshipareadvisedtoseekareferencefromtheirLocalAuthority.
i)Name:
Position: Address:
Telephonenumber:
Emailaddress(wherepossible):
ii)Name:
Position: Address:
Telephonenumber:
Emailaddress(wherepossible):

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8.SUPPORTINGSTATEMENT

Yourapplicationshouldbesupportedbyaletterofnotmorethan3sidesofA4(12pt),addressingthecriteriainthe personspecification for thispost.

9.LEADINGANDTEACHINGINA CHURCHOFENGLANDSCHOOLORACADEMY
Wewelcome,asteachersandothermembersof staff,peopleofmanyfaithsandbeliefs.Wedo,however,ask thatall staffshouldsupportthevalues,ethosandphilosophyofaChristianschool,inthetraditionoftheChurch ofEngland, andwewouldexpectstafftomakeapositivecontributiontothedevelopmentofthat
Christianethos.
Weexpectourschoolleaders todemonstrateaclearcommitmenttotheChristianethos.
IfyouareapractisingmemberofaChristianChurch,pleasegivedetails:
Denomination: Place ofWorship: Address:
Diocese(ifapplicable):
Ifpossiblepleasegivethenameofaparishpriestorministerfromwhomareferencemaybesought:
Name: Address:
Telephonenumber:
PleaseaddabriefstatementhereinsupportofyourapplicationtothisChurchofEnglandschool:

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PartB–CONFIDENTIALINFORMATION
Thissectionoftheformwillberemovedbeforeshortlisting.
1.Gender:
2.DateofBirth:
3.Cultural/ethnicorigin:
4.Ethnicityform:
ChoseonesectionfromA-Eandthenticktheappropriateboxtoindicateyourculturalbackground.
AWhiteCAsian,AsianBritish,AsianEnglish,Asian
BritishScottish,orAsianWelsh
EnglishIndian
ScottishPakistani
WelshBangladeshi
Other,pleasewriteinAnyotherAsianbackground,pleasewritein
Irish
AnyotherWhitebackground,pleasewriteinDBlack,Black British,BlackEnglish,BlackScottish,orBlackWelsh
BMixedCaribbean
WhiteandBlackCaribbeanAfrican
WhiteandBlackAfricanAnyotherBlackbackground,pleasewritein
WhiteandAsian
AnyotherMixedbackground,pleasewriteinEChinese,ChineseBritish,ChineseEnglish,ChineseScottish,ChineseWelsh,orotherethicgroup
Chinese
Anyotherbackground,pleasewritein
5.CriminalHistory
Thepositionyouareapplyinginvolvescontactwithchildren andisexemptfromtheRehabilitationofOffenders Act 1974andallsubsequentamendments(EnglandandWales).Forthispositionyouarenotentitled towithhold informationaboutpolicecautions,“bind-overs”,oranycriminalconvictionsincludingany thatwouldotherwisebe considered“spent”undertheAct.
Haveyoueverbeenconvictedofanyoffenceor“bound-over”orgivenacaution?Yes
 No
Ifyes,pleasegivedetailsonaseparatesheetandattachit tothisforminasealedenvelopemarked
“ConfidentialDisclosure”.
Iunderstandthatif myapplicationissuccessfulIwillberequiredtoobtainaCRBDisclosureatthe appropriate level.
6.WorkStatus
IunderstandthatunderthetermsoftheAsylumandImmigrationAct1996shouldI beshort-listedforthepost for whichI amapplying,I willprovideforthegoverningbody,asemployer,anoriginaldocument*showing myentitlementtoworkinthiscountry.
*AcceptabledocumentsincludeyourNationalInsurancecard,abirthcertificateissuedintheUKorEire,a P45 fromyourpreviousemployer,avalidpassport,oranyrelevantauthorisationallowingyoutoworkin thiscountry.

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7.Otherinformation

Areyourelatedtoanymemberofthegoverningbody,LAelectedmember,seniorLAofficialorofficerof

LDBS?

Yes No

Ifyes,pleasegivedetails:

Youareremindedthatanycanvassing,directorindirect,willdisqualifycandidates.Successful candidatesmayberequiredtoproducetheirbirthcertificateandoriginalproofof

qualificationsandundergomedicalexamination.

Declaration

Tothebestofmyknowledgetheinformationonthisformiscorrect.

Iaminpossessionofcertificates,whichI claimtohold.

Iunderstandthatwillfulfalsificationoromissionsmay,if I amappointed,resultinmydismissal.I declare thatI amnotonList99ordisqualifiedfromworkingwithchildren.

Iamnotsubjecttoanysanctionimposed bytheGeneralTeachingCouncil.

IconsenttotheprocessingofpersonaldataasdefinedintheDataProtectionAct1998.

Signature

Date

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