Where Our Dreams Begin!

Position/s: (Tick what you wish to be considered for)

¨ JOB 1: 2017 Teacher

- New Entrant Team Teaching 0.7FTTE

- Classroom Release Support 0.3FTTE

¨ Job 2: 2018 Classroom Teacher

Status: Job 1: Full Time, Fixed Term

Start as soon as possible, until end of 2017

Job 2: Full Time, Fixed Term (Maternity Leave conditions)

Start Term 1 2018 – End of Term 4, 2018

Contract: Collective Employment Agreement or relevant IEA

Personal Details

______(Surname)

______(First Names)

Any aliases, changes of names, commonly used or alternative names.

______

______

Facebook: ______

Instagram: ______

Twitter: ______

Linkedin: ______

Contact Information: ______(Address)

______

______

______

( ) ______(Telephone Number)

( ) ______(Fax Number)

( ) ______(Cell Phone Number)

______(E-mail Address)

MOE Number: ______

Teachers’ Registration Number: ______Expiry Date: ______

Please provide two photographic verified copies of proof of identity. For example a drivers licence, passport, firearms licence. Please also provide a verified copy of your Teachers Registration card.

Formal Qualifications
Degrees / Diplomas / High School Certificates etc. / Date Attained

(Include an appendix if you have more qualifications than the provided space.

Please provide verified copies of all formal qualifications. )

Non-Teaching Employment Details

Employer / Position / Duration

(This must span at least the last five years.

Include an appendix if you have more non-teaching experience than the provided space.)

Teaching Employment Details

School / Level
(e.g. Year Four) / Duration
Total Full Time Teacher Experience / ______years

(This must span at least the last five years.

Include an appendix if you have more teaching experience than the provided space.)

Wider Whole School Formal Responsibilities

School / Responsibility
(e.g. Lead Teacher of Maths, Assistant Principal, Reading Recovery) / Duration

(Include an appendix if you have more responsibilities than the provided space.)

Event Leadership and Co-ordination

School / Specific Event / Responsibility
(e.g. camps, ski trips, productions, cross countries, athletics) / When
(i.e. year/s e.g. 2011)

(Include an appendix if you have organised, coordinated or led more events than the provided space allows for.)

Professional Development

Course / Content Focus / When

(Include an appendix if you have had more professional development courses,

conferences and contracts than the provided space allows for.)

Convictions?

Have you ever been convicted of any offence against the law (apart from minor traffic convictions)

q Yes

q No

If “Yes”, please enclose a certified copy of the entry in the Criminal Record Book relating to the conviction/s, obtained from the Registrar of the Court concerned. The copy should be accompanied by any comments regarding the offence that you wish to make. Give full details.

Please note that all employees within the education sector are required to undertake regular police vetting. Teaching staff have this actioned as part of their registration. Non-teaching staff have this process actioned by the school. The appointment of a non –teaching staff member is subject to a successful police vet. If there are concerns relating to the result of a police vet the Board of Trustees reserves the right to withdraw any offer of a position. More information can be found - http://www.police.govt.nz/service/vetting

Are you in the process of any pending court summons, appearances or currently on bail awaiting trial?

q Yes

q No

If “Yes”, please enclose details of this.

Health

Do you have any medical conditions either by accident, gradual process, disease or infection which would hamper your ability to consistently fulfil your job description or be aggravated by fulfilling your job description?

q No

q Yes (please specify)______

______

Appraisal

Have you been subject to a failed appraisal, competency or dismissal in any of your previous work places?

q No

q Yes (please specify)______

______

Referees

Please provide details of three people who can be contacted as referees.

These people must be able to verify your work ability and be able to honestly answer questions relating to your character as a person.

Of these three one must be your most recent previous employer e.g. Principal, Board of Trustees Chairperson.

Please ensure that contact details include home and cell phone numbers so that people can be contacted outside of school hours.

Name / Position /

Phone Number/s

Work / Home / Cell
Confirmation, Understanding & Permission

I certify that the information given in this application is, to the best of my knowledge, is true and correct. I understand that if I have actively and knowingly provided false details that lead to securing employment then the Board of Trustees of Edendale Primary School will view this as serious misconduct and apply the relevant sections of the employment agreement e.g. Primary Teachers Collective Employment Agreement.

I understand the Board of Trustees and/or its agent may seek verification regarding my skills as an employee and character as a person from wider sources than the referees and those provided.

In signing below I give my confirmation, understanding and consent to the above.

______(Signed) ___ - ___ - 2017

At Edendale Primary School we are…confident, connected, actively involved, lifelong learners.