Thank you for your interest in working at South Devon UTC. Please complete the
form in full. We will treat the information you provide as private and confidential.
Post applied for:
Post reference number: / Dates unavailable for interview:
Where did you see this vacancy advertised?
Personal Details
First names:
Surname:
Known as:
Address:
Postcode:
Telephone: / Home: / Work:
Email: / Mobile:
May we contact you at work? / No / Yes
National Insurance Number:
Previous Surname if applicable:
Have you worked for the South Devon UTC before? / No / Yes / Dates:
Are you related to an employee of South Devon UTC? / No / Yes:
If yes, please give name:
If yes, please give relationship:
Are you permitted to work in the UK in accordance with the immigration and Asylum Act 1996? / No / Yes
Education & Training
Name of Secondary School(s): / Dates
attended
(mm/yy),
From/to: / Examination/s taken:
State subjects / Grade(s) achieved:
Please state highest level of English and Mathematics qualifications
Name of College/University / Dates
Attended
(mm/yy),
From/to: / Examination/s taken: / Grade/s achieved:
Membership of Professional Bodies / Date of membership
(mm/yy) / By Examination
(Yes/No) / Level/Grade of membership
Other Professional Qualifications / Date obtained / Grade/Level / Awarding body
Teaching Qualifications, Training & Registration (If Relevant)
What Teaching qualifications have you achieved? Please tick / PGCE / 7407 Stage 1 / PTLLS / Other
Cert Ed / 7407 Stage 2 / CTLLS
DTLLS
Have you registered with the Institute For Learning (IFL)? If YES please indicate the membership number / Membership No. AB / Registration Status
- Full
- Associate
Do you have Assessor / Verifier Awards? Please indicate / D32/33 / D34 / D35 / D36
A1 / V1 / V2
Please give an overview of your teaching experience and levels taught including Skills For Life.
Training & Continuous Professional Development
You will be asked to give evidence of Continuous Professional Development (CPD) at your interview. Please include any details that are relevant to the post you are applying for.
Current or Most Recent Employer
Name of Employer: / Address:
Job Title:
Principal duties and responsibilities:
Type of business:
Final Salary:
Dates employed: / From (mm/yy): / To (mm/yy):
Reason for leaving:
Notice period:
Previous Employment
Please list in chronological order beginning with most recent employer. All Employment must be included and gapsaccounted for. Continue on an additional page if necessary.
Name of Employer: / Address:
Job Title:
Principal duties and responsibilities:
Type of business:
Final Salary:
Dates employed: / From (mm/yy): / To (mm/yy):
Reason for leaving:
Name of Employer: / Address:
Job Title:
Principal duties and responsibilities:
Type of business:
Final Salary:
Dates employed: / From (mm/yy): / To (mm/yy):
Reason for leaving:
Name of Employer: / Address:
Job Title:
Principal duties and responsibilities:
Type of business:
Final Salary:
Dates employed: / From (mm/yy): / To (mm/yy):
Reason for leaving:
Personal Statement
This page has been provided so that you can include any information that may support your application in greater detail.Please give consideration to how your skills, experience and disposition relate to the job description and the personspecification for this post. If necessary, please continue on another page, which should be attached. Please keep yourpersonal statement to two sides of A4.
Other Attributes
Please include any information that you feel is relevant, which may enhance your contribution to the UTC:
South Devon UTC Application - Self-Disclosure Form
South Devon UTC aims to promote equality of opportunity for all job applicants with the right mix of skills and potential. We welcome applications from a diverse and representative community. A criminal record will not necessarily be a bar to obtaining employment. Each case is considered on its own merit.
All information you provide will be treated as confidential and managed in accordance with relevant data protection legislation and guidance. You have a right of access to information held on you under the Data Protection Act 1998.
Are you registered with the Independent Safeguarding Authority?
Yes/No Reg. No.
Have you ever been known to any children’s services department or to the police as being a risk or potential risk to children? / Yes / No
If yes, please provide further information:
Have you been the subject of any disciplinary investigation and/or sanction by any organisation due to concerns about your behaviour towards children? / Yes / No
If yes, please provide further information:
Do you have any convictions, cautions, reprimands or final warnings that are not “protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amended) 2013? / Yes / No
If yes, please provide further information (you may continue on an additional A4 sheet):
Confirmation of Declaration (please tick below)
I agree that the information provided here may be processed in connection with recruitment purposes and I understand that an offer of employment may be withdrawn or disciplinary action may be taken if information is not disclosed by me and subsequently come to the organisation’s attention.
In accordance with the organisation’s procedures, if required, I agree to provide an existing valid DBS certificate and consent to the organisation clarifying any information provided on the disclosure with the agencies providing it.
In accordance with the organisation’s procedures, I agree to the information provided being used to carry out an enhanced DBS check and understand any job offer is dependent upon this being completed successfully.
I agree to inform the organisation within 24 hours if I am subsequently investigated by any agency or organisation in relation to concerns about my behaviour towards children or young people.
I understand that the information contained on this form, the results of the DBS check and information supplied by third parties may be supplied by the organisation to other persons or organisations in circumstances where this is considered necessary to safeguard children.
Signature of candidate:
Print name:
Date:
The following information is for administration purposes only and will not be submitted with the rest of your application form, to the selection panel. All information disclosed will be used for pre-employment checks and our own equal opportunity and diversity monitoring purposes. However, if any checks or disclosures reveal any safeguarding concerns then we are obligated to report these to the Local Governing Safeguarding Boards. Please read the full Data Protection Statement and Declaration at the end of this document.
References
Please supply us with the names and addresses of two referees who are in a position to provide relevant comment onyour work performance. These should not be family members. One referee MUST be your current or last employer. The reference from your current, or last, employer should be a senior person to whom you report and who knows yourwork.
Please note that references will be taken up prior to interview unless otherwise indicated.
Name: / Name:
Job Title or Occupation: / Job Title or Occupation:
Dates covered: / Dates covered:
Address: / Address:
Tel No: / Tel No:
Email address: / Email address:
Can we contact this referee with immediate effect? / Yes / No / Can we contact this referee with immediate effect? / Yes / No
Pre-employment Checks for Teaching Staff
To ensure we comply with the Safer Recruitment in Education guidance we need to check your qualified teaching status and that you have no sanctions in place, and are not prohibited from teaching in the UK. To do this, we need the following information;
Are you a member of the General Teaching Council? / Yes / No / Are you registered with any other organisation? If yes, please supply details:
Teacher Reference Number: / Date of Birth:
Data Protection Statement
South Devon UTC will process personal information provided by you in the application form and any other personal information provided by you now or in the future, in accordance with the Data Protection Act 1998, to assist us in considering your application for employment and, if you become an employee, for purposes relating to your employment.
For selection purposes, your personal information will be considered by our Human Resources team and where appropriate, relevant managers of the South Devon UTC partnership. Any appointment will be subject to references and the completion of a medical questionnaire.
Should your application be unsuccessful, it will be kept by the Human Resources Department for six months, and then destroyed.
If you are successful, the information provided by you will be held in your personal file and will be held on the South Devon UTC database. Should you leave, your information will be held for a reasonable period of time in line with Human Resources practice, including the purpose of providing references and dealing with queries in connection with your employment.
Data Protection Declaration
I declare that to the best of my knowledge and belief all the statements and information given in this form are true and complete, and that I have now withheld any material fact. I understand that any appointment will be made on the basis that the information given on this form is true and correct. I understand that if I have failed to disclose information, or have given incorrect information, this could lead to an offer of appointment being withdrawn, or in disciplinary action or dismissal at a later date.
I consent to South Devon UTC obtaining information or references from any previous employers, or other company or institution which the South Devon UTC considers appropriate. I also consent to those previous employers releasing information about my sickness absence while in their employment for those references.
I have read and understood the Data Protection Statement and consent to the South Devon UTC processing any personal information as described in that section.
I understand that the South Devon UTC will ask for evidence of relevant qualifications at the interview as well as personal photo identification, proof of address and evidence of my right to work in the UK.
Signature …………………………………………………………………………………………. Date ………………………………………….
If you are completing this form on-line, then you will be asked to sign if called for interview.
Please email or post your application to:
Jennifer Wain
Strategic Business Leader
South Devon UTC
Kingsteignton Road
Newton Abbot
TQ12 2QA
Email:
Web:
Tel: 01626 240201
If you have not heard from South Devon UTC within 4 weeks of the closing date,
please assume that you have not been shortlisted on this occasion.
Equal Opportunities and DiversitySouth Devon UTC is committed to promoting equal opportunity and diversity in employment, in respect of our recruitment and selection procedures and in ensuring that all employees receive equal treatment in employment and to comply with relevant legislation.
We seek to employ a workforce which reflects the diverse nature of our community and value the contribution of each individual regardless of sex, age, marital status, disability, sexual orientation, race, colour, religion, ethnic or national origin.
In order to promote Diversity, monitor the effectiveness or our policies in accordance with best practice, the relevant Codes of Practice and our legal obligations under the Race Relations (Amendment) Act 2000; we need to record the ethnicity of all current employees and applicants for employment. We would, therefore, be grateful if you would complete the details in line with our commitment to promoting diversity.
FAILURE TO COMPLETE THE INFORMATION BELOW WILL RESULT IN THE SOUTH DEVON UTC NOT CONSIDERING YOUR APPLICATION.
Responses will be treated in the strictest of confidence and will be held separate from individual employment records. The information you provide will form a confidential database, which will be used for statistical analysis only and help evaluate progress towards improvement in the South Devon UTC strategy.
The information will be held in compliance with the Data Protection principles as set out in the Data Protection Act 1988. Should you become an employee, we will seek periodic confirmation from you as to its accuracy.
What is your ethnic origin?
White – British/English/Welsh/
Scottish/Northern Irish / Mixed - White and Black Caribbean
White - Irish / Mixed - White and Black African
White – Gypsy or Irish Traveller / Mixed - White and Asian
White - other / Mixed - Other
Indian / Black – British
Pakistani / Black - Caribbean
Bangladeshi / Black - African
Chinese / Black - Other
Asian - Other / Arab
Other
Equal Opportunities
As an employer, The South Devon UTC is committed to ensure people with disabilities are treated fairly, to enable them to carry out their role effectively. The Disability Discrimination Act 1995 (Amendment) Regulations 2003 and Special Educational Needs and Disability Act 2001 define 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 and which has lasted for at least 12 months or is likely to last for 12 months.
This information is only for monitoring purposes.
Do you consider yourself to have a disability? / Yes / No
If ‘yes’, please provide general details:
Gender / Male / Female
Age range / 16-20 / 21-30 / 31-40 / 41-50 / 51-60 / 61-65 / 66-70 / Over 71
Thank you for taking the time to complete this form.
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