OUR LADY’S CONVENT HIGH SCHOOL
‘Shaping Tomorrow, Inspired by Faith’
APPLICATION FORM
Please complete this form and send to
Post Title…………………………………………………………………………………………………………………………..
Surname……………………………………………………………………………………………. (Mr/Mrs/Miss/Dr etc.)
First Name(s)………………………………………………………………………………………………………………….
Address…………………………………………………….Telephone (Home)…………………………………………….
………………………………………………………………(Work)……………………………………………...
………………………………………………………………Would you object to being contacted at work?
YES/NO......
………………………………………………………………
Post Code………………………..
Date of Birth……………………… Age…………………. National Insurance Number…………………………………...
Are you required to hold a work a work permit YES/NO…………… D.F.E Number (if applicable)…………………….
REFEREES (if possible one referee should be your present or last employer).
1. 2.
Name…………………………………………………….. Name……………………………………………………….
Position…………………………………………………..Position……………………………………………………..
Address…………………………………………………..Address…………………………………………………….
…………………………………………………………….………………………………………………………………
…………………………………………………………….………………………………………………………………
Telephone No…………………………………………...Telephone………………………………………………….
Please give any dates on which you will NOT be able for interview.
PRESENT OR LAST EMPLOYMENT
Post:………………………………………………Date commenced:…………………...
Name and address of employer:Grade/salary: ……………………
…………………………………………………….Reason for leaving/wishing to leave:
…………………………………………………………………………………………………..
…………………………………………………………………………………………………..
…………………………………………………………………………………………………..
Date left (if applicable)………………………………………………………………………..
Outline of main duties:
PREVIOUS EMPLOYMENT (Most recent post first)
Dates
From
ToEmployer (including
Name and address)
Post title/main dutiesReason for leaving
EDUCATION AND QUALIFICATIONS
Please give details of your education and qualifications (most recent first)
Dates
From
ToSchools, College
University, etc.Subject(s) studiedQualifications/
Certificates/Grades
WORK RELATED QUALIFICATIONS/MEMBERSHIP AND NVQ’S ETC.
Dates
From
ToDetails: Name of Association Institute/QualificationsLevel/or grade of membership
RELEVANT TRAINING
Dates
From
To
Title of course
Details
Where did you see this post advertised?
DISCLOSURE OF CRIMINAL AND CHILD PROTECTION MATTERS
Have you ever been the subject of any child protection concern either in your work or personal life, or disciplinary action in relation thereto, including any which is time expired? YES NO
The Governing Body is obliged by law to operate a checking procedure for employees who have substantial access to children and young people.
I confirm that I am not disqualified from working with children and/or included on the DfE List 99.
Signature:
REHABILITATION OF OFFENDERS ACT 1974
If you have no convictions, simply enter “NIL”. If you have been convicted of any criminal offence, the details must be listed below, together with any cautions or bind-overs, pending criminal convictions,any pending criminal actions or court hearings against you. Please enclose this form in a sealed envelope marked ‘confidential’.
Date of conviction / pending hearingOffenceSentence
CRIMINAL RECORDS BUREAU
In the event of a successful application an Enhanced Disclosure will be sought from the Criminal Records Bureau in relation to criminal and child protection matters. A conviction will not necessarily be a bar to obtaining employment.
Please sign here if you agree that the appropriate enquiry may be made to the Criminal Records Bureau about the existence and content of any criminal record.
Signature:
DATA PROTECTION ACT 1998
I hereby give my consent for personal information (including recruitment monitoring data) provided as part of this application to be held on computer or other relevant filing systems and to be shared with other accredited organisations or agencies in accordance with the Data Protection Act 1998.
Signature:
IMMIGRATION, ASYLUM AND NATIONALITY ACT 2006
In accordance with the Immigration, Asylum and Nationality Act 2006, the Governing Body will require new members of staff to provide documentary evidence that they are entitled to undertake the position applied for/have an ongoing entitlement to live and work in the United Kingdom.
I confirm that I am legally entitled to work in the UK.
Signature:
DECLARATION
If you know that any of the information you have given on this application form is false or if you have knowingly omitted or concealed any relevant fact about your eligibility for employment then your name will be withdrawn from the list of candidates.
Providing false information is an offence and could result in this application being rejected. If such a discovery is made after you have been appointed then you will be liable to be dismissed summarily. You may also be referred to the Teachers’ Misconduct Team or the Police, if appropriate.
I hereby certify that all the information given by me on this form is correct to the best of my knowledge, that all the questions relating to me have been accurately and fully answered and that I possess all the qualifications which I claim to hold.
I acknowledge that it is my responsibility as the candidate, if invited for interview, to disclose any information to the panel which may affect working with children and/or vulnerable adults.
Signature: Date:
Please use this section to support the information that you have already provided regarding your suitability for this post and how you meet the requirements of the post. Include everything that is relevant, such as training and experience gained through out of work activities, as concisely as possible.
Continue on a separate sheet(s) if there is insufficient space on this form.
This information that I have provided on this application form is true and correct.
Signed:…………………………………………..Date:………………………..
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6-16 Amhurst Park London N16 5AF Telephone: 020 8800 2158 Email: