Confidential

This form is to be used by a selection panel on completion of the selection panel’s assessment and ranking of applicants for a position advertised under Part 2.4 of the Education and Training Reform Act 2006 andto identify the recommended applicant. Information in relation to recruitment and selection is available at: Recruitment in Schools(

Vacancy details
Vacancy Reference Number (Job Opening ID from ROL): / Time Fraction: ___ . ______
School: /  Ongoing
 Fixed term Fixed term end date: ____/____/______
Classification: /
Salary Range (if applicable):
Applicant recommended by panel:
Name:
Current classification (If employed by the Department):
Current employer (If not employed by the Department):
Preferred applicants ranked in order of merit
Ranking / Name
Names of applicants not shortlisted / Reasons for not shortlisting
Reasons for not interviewing a short listed applicant (if applicable):
Comparative assessment of shortlisted applicants
Name / Comparative assessment against the selection criteria (taking into account application, interview, referee comments and other selection tools)
Panel signatures
(Any actual, potential or perceived Conflict of Interest has been declared to the panel and entered on the Declaration – Conflict of Interest form in eduPay)
Position / Name / Gender / Merit Trained
Panel Chairperson / Signature: ______
Full Name: ______
Date: ___ / ___ / ______/ Male
Female / Yes
No
Panel Member / Signature: ______
Full Name: ______
Date: ___ / ___ / ______/ Male
Female / Yes
No
Panel Member / Signature: ______
Full Name: ______
Date: ___ / ___ / ______/ Male
Female / Yes
No
Principal’s decision
The selection panel’s recommendation is:
Approved
Not approved
Name of successful applicant if the selection panel’s recommendation is not accepted:
Name: ______ / Reasons for not accepting the selection panel’s recommendation:
Principal’s signature: ______Date: ____ / ____ / ______

This selection report is to be retained by the school for two years after the date of the selection decision. This report remains the confidential property of the school and may be destroyed two years after the date of the selection decision.

INDIVIDUAL SELECTION REPORT (to be completed for each shortlisted applicant)
Name of applicant: / Date report prepared: ____ / ____ / ______
Position applied for:
Selection criterion / Assessment against each selection criterion
(Based on application, interview, referee comments and other selection tools) / Criterion Met (Y/N)
1
2
3
4
5
6
Names of referees contacted (indicate if referee was nominated or not nominated)
Name / Nominated (Y/N)
Applicants
Names of all applicants / Gender / Current work location or current employer if not a current employee

Selection Panel Report – Teaching Service