SEAX Multi-Academy Trust

SEAX Trust

SEAX Multi-Academy Trust

Company Number: 07747149

Registered Company Address: Thriftwood School, Slades Lane, Galleywood, Chelmsford, Essex CM2 8RW

Staff Application Form

Applicant Surname (CAPITAL LETTERS):
Please return your completed application form for Thriftwood School to:
PA to Headteacher
Thriftwood School
Slades Lane
Galleywood
Chelmsford
Essex CM2 8RW

Thank you for your interest in this post.

The following information is necessary to ensure that full consideration can be given to all candidates. The information given will be treated as confidential.

The SEAX Trust is committed to safeguarding and promoting the welfare of children and young people and expects all staff and volunteers to share in this commitment. All posts are subject to satisfactory medical checks, enhanced DBS clearance and references.

Please complete the application form in BLACK INK, BALLPOINT or TYPE (in no smaller than size 10 font please) and ensure you complete all the sections. The Declaration must be signed and can be found at the end of this form. If you are completing this form on line, your typed signature certifies the information you have given.

POST DETAILS
Application for appointment as:
Do you need permission to work in the UK?

Sect

Personal Details /
Surname and title (Mr/Mrs etc): / First name(s)
Please give first and middle names:
Previous Surnames: / Date of birth:
Home telephone number: / Home email address:
Work telephone number: / Work email address:
Mobile Number: / [ ] / National Insurance Number: / [ ]
Address including postcode:
Present or most recent Employment Details /
Current or most recent employer’s name and address:
If you are not currently employed please state year in which you last held paid employment:
Nature of business:
Job title: / Month & year appointed:
Grade/Salary Spine: / Current salary (point):
Notice required: / Allowance(s) received Type(s):
Reason for leaving: / Allowance Received Value(s): £
Brief outline of duties in your Current or Most Recent Job
Please give a general outline only. /

Section 3

Section 4

Section 7

Previous Employment: Please include all full time and part time positions since leaving education, listing the most recent first and continuing on a separate sheet if necessary: /
Employer / Start date
MM/YY / End date
MM/YY / Job Title / Salary/ Grade / Reason for leaving
Breaks in Employment
If you have had any breaks in employment since leaving school, please give details of these periods and your activities during these times e.g. unemployment, raising family, voluntary work, training, long periods of sickness etc. /
Mobility / Yes / No /
Do you a have valid driving licence?
Do you have access to a vehicle which you are able to use for work purposes?
If not, are you able to travel, for work purposes, by another means of transport?

Section 5

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Section 8

Section 11

Secondary Education
Please list schools attended with the most recent school first:
School Name: / Attended From/To: / Qualification Type
(eg GCSE) & Subject: / Grade Attained: / Date:
Continuing Education
(University/College/Apprenticeships etc.) Please list most recent first: /
Educational establishments / From / To / Qualifications/subject obtained / Level/grade / Dates
Professional Qualifications
Including details of professional association memberships: /
Do you hold Qualified Teacher Status? YES/NO / DfE Number:
Do you hold QTLS? YES/NO / Date Achieved:
Other Qualifications held: / Dates:
Other relevant training and development activities attended in the last 5 years
Please list most recent first and continue on a separate sheet if necessary /
Course Title/Brief Description: / Organising Body: / Date:
Information in support of this application
Please use the person specification as a prompt to describe the experience, skills, competencies and qualifications that make you suitable for this job. These may have been gained from your work experience, any voluntary or community work you have undertaken, or relate to any other organisation you may have been involved with. For teaching staff, these may include specialist teaching experience.
We would also like to know about you personally and you may wish to include details of your interests and why you think you would like to join the SEAX Trust staff (please continue on a separate sheet if necessary).
References
Please give the names and addresses of your two most recent employers
If you are unable to do this, please state the reason and then clearly outline who your references are /
Full Name and Address: / Full Name and Address:
Position / Position
Telephone number / Telephone number
e-mail address (Must be given) / e-mail address (Must be given)
Notes:
·  IT IS OUR STANDARD PRACTICE TO CONTACT ALL REFEREES BEFORE INTERVIEW – Please let us know if this presents any difficulty
·  References from other schools/colleges must be signed by the Head Teacher
·  If either of your referees know you by another name please give details
·  References from anyone other than a previous employer will only be accepted from a professional person such as a doctor, teacher, solicitor etc
·  References will not be accepted from relatives or from people writing solely in the capacity of friends
Close Personal Relationships /
Are you a relative or partner, or do you have a close personal relationship with, any employee, Governor, Director or Member of SEAX Trust?
Failure to disclose a close personal relationship as described above may disqualify you. / YES/NO
If ‘yes’ please state the name(s) of the person(s) and relationship.
Please Note: Canvassing of Members, Directors, Governors or Senior Managers of the Trust by you or on your behalf is not allowed:
Please confirm the following statements are true by signing the box below
If you are completing this form on line your typed signature certifies the information you have given: /
Declaration
I certify that, to the best of my belief, the information I have provided is true and I understand that any false information will result, in the event of employment, in disciplinary investigation by SEAX Trust, and is likely to result in dismissal.
Disclosure of Criminal Convictions
Short-listed candidates will be asked to complete a ‘Disclosure of Criminal Convictions’ form, a ‘Self-Disclosure Disqualification’ form and, where appropriate, a Disclosure will be sought from the Disclosure & Barring Service in the event of a successful application. A conviction will not necessarily be a bar to obtaining employment.
Safe Recruitment
I certify that I am not disqualified from working with children or subject to sanctions imposed by a regulatory body which would restrict me from applying for this post.
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.
Signed: / Date:

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Recruitment Monitoring Information 16

Post Title:
Last name: / First name:
Date of birth:

SEAX Trust is committed to ensuring that applicants are selected on the basis of their abilities relevant to the job. Completion of this section will help us to ensure that our policies and procedures are effective in avoiding discrimination and promoting equal opportunities in recruitment. The information you provide will be used for monitoring and statistical data purposes only and will not be seen by the shortlisting panel. This section will be detached from the application form prior to shortlisting. If you do not wish to share any/all of this information, you are at liberty to withhold it.

The categories below are in line with the 2011 Census: /
Ethnic origin
I would describe my ethnic origin as:
1. White: / 4. Asian or Asian British
British / Bangladeshi
Irish / Indian
Any other white background / Pakistani
Please specify... / Any other Asian background
2. Black or Black British / Please specify...
African / 5. Chinese or British Chinese
Caribbean / 6. Other ethnic group
Any other black background / Please specify...
Please specify...
3. Mixed / Gender
White and Asian / Female
White and Black African / Male
White and Black Caribbean / Marital status
Any other Mixed background / Married
Please specify... / Not Married

The information contained on this form will be held on a computer file.

For our own Information /
It would help us to know how you heard about this post. Please let us know by indicating below:
Advert on Academy/Trust Website:
Advert in the local/national press:
Banner outside School/College:
Word of mouth: / Advert on Essex Schools Jobs Website:
Advert in Jobscene Magazine:
Advert on School/College Noticeboard:
Other (please state):
Disability
Before ticking the appropriate box below please read the definition of disability.
The definition of disability, as outlined in the Equality Act 2010 is as follows: “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”.
To be protected under the Act:
An individual must have an impairment which can be physical or mental.
It has to be substantial, that is something more than minor or trivial.
It needs to be long term i.e. The impairment has lasted or is likely to last in total for at least twelve months or more, or is likely to last for the rest of the life of the person affected (long term includes conditions which fluctuate or may recur such as cancer, HIV/AIDS and multiple sclerosis) and
It must affect their day-to-day activities on a regular basis (day-to-day activities includes things such as reading, lifting and carrying objects, personal care, shopping, meeting and communicating with people. The effect of your impairment on everyday activities is considered as it would be without medication or aids. The only exception is eyesight which should be judged when an individual is wearing their usual lenses or spectacles).
I do consider myself to have a disability as defined by the Equality Act 2010 (as detailed above) / I do not consider myself to have a disability as defined by the Equality Act 2010 (as detailed above)
I prefer not to say / [ ]
Data Protection Act /
I hereby give my consent for the Recruitment Monitoring Information provided on this form 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
Signed: / Date: