Waitakere

Seventh-day Adventist School

Job Application Form

APPLICATION FOR APPOINTMENT TO A TAGGED POSITION

PROPRIETOR’S SPECIAL CHARACTER FORM

Member of the New Zealand Seventh-day Adventist Schools Association

Note to Applicants

This form is to be completed by all persons applying for a tagged teaching position in a Seventh-day Adventist School. The Private Schools Conditional Integration Act 1975 requires Proprietors of State Integrated Schools to approve applicants in terms of their acceptability to fill positions in terms of the Special Character of the School prior the Board of Trustees making an appointment.

Footnote to Applicants:

Subject to evidence that applications made to the Education Council NZ and that all Teaching qualifications meet the NZ Qualifications Authority, and approval of your application, the Board has the right to decline applications submitted to the principal for the position advertised.

POSITION APPLIED FOR: / Principal Teacher
APPLICANT’S FULL NAME:
ADDRESS INFORMATION:
HOME PHONE NUMBER:
MOBILE PHONE NUMBER:
EMAIL ADDRESS:
EDUCATION COUNCIL NZ’S
TEACHER REGISTRATION NUMBER:
EXPIRY DATE:
CATEGORY: / Full Provisional STC
(Circle appropriate category above)
PERSONAL INFORMATION: / Gender:
Place of Birth:
NZ citizen NZ resident Work visa
(Circle appropriate category above)
CHURCH AFFILIATION:
Name of church currently attending and name of Pastor/Minister:
Are you willing for the Board Chair to contact the Pastor/Minister of your Church for a personal Reference?
Name and phone number/s of Pastor/Minister:
Are you a baptized member of the SDA Church? / Yes No
If ‘Yes’, where is your church membership held?

TERTIARY EDUCATION QUALIFICATIONS:

What degrees, diplomas or other professional qualifications do you hold?

Institution Attended / Na Year / Yea Qualification Attained / Date Awarded

PRESENT EMPLOYMENT:

Name of present employer/school / Position held / Length of Service/Date commenced
Address of present employer / Work phone / Salary scale

PROFESSIONAL MEMBERSHIPS, please give details below:

TEACHING SERVICE HISTORY (Please list your work experience / responsibilities for the last 5 years, beginning with your most recent position.)

Position Held / School / Reason for Leaving / Date From / Date To
REFEREES: / Please supply the names and contact details of:
·  three Professional Referees and
·  three Character Referees
PROFESSIONAL Referee 1
Name:
Relationship to you:
Address:
Home phone:
Mobile phone:
E-mail address:
PROFESSIONAL Referee 2
Name:
Relationship to you:
Address:
Home phone:
Mobile phone:
E-mail address:
PROFESSIONAL Referee 3
Name:
Relationship to you:
Address:
Home phone:
Mobile phone:
E-mail address:
CHARACTER Referee 1
Name:
Relationship to you:
Address:
Home phone:
Mobile phone:
E-mail address:
CHARACTER Referee 2
Name:
Relationship to you:
Address:
Home phone:
Mobile phone:
E-mail address:
CHARACTER Referee 3
Name:
Relationship to you:
Address:
Home phone:
Mobile phone:
E-mail address:
OTHER INFORMATION
Have you had any injury or medical condition which the tasks of this position may aggravate or contribute to, or know of any reason why you might have difficulty carrying out the job description attached?
5 Yes 5 No
If yes, please give details below:
Do you have any matters relating to yourself currently or previously before the Education Council NZ?
5 Yes 5 No
Do you have a current New Zealand driver licence? 5 Yes 5 No
Do you give permission for your police record to be checked? 5 Yes 5 No
Have you changed your name by deed poll/statutory declaration? 5 Yes 5 No
Other names known by: ______
PRIVACY ACT 1993 (To be signed by the Applicant):
This Application is submitted with the understanding that any further information given is for the use of the employer and their authorised representatives who may at any time have access to this information. Furthermore, consent is given for the Board Chair or their delegate, to make enquiries of my present or past employers or colleagues or any other person who may assist in establishing my suitability for the position of Principal at this school.
·  I authorise the Board, or nominated representative, to approach persons other than the referees whose names I have supplied, to gather information related to my suitability for the appointment to the position
5 Yes 5 No
·  I authorise the Board, or nominated representative, permission to access any information held by the Education Council of Aotearoa New Zealand (EDUCANZ) or any other educational organisation, including information regarding matters under investigation, to gather information related to my suitability for the appointment to the position.
5 Yes 5 No
APPLICANT’S SIGNATURE: ______DATE: ______
DECLARATION:
HAVE YOU EVER BEEN CONVICTED OF AN OFFENCE AGAINST THE LAW? (Apart from minor traffic offences).
·  Have you received police diversion for an offence, have charges pending or know of any reason why you should not be employed to work in a school environment? 5 Yes 5 No
·  Have you ever had been the subject to any concerns involving child safety? 5 Yes 5 No
If YES, please provide date and details of the offence (s) on a separate sheet. Please note that you may be asked to provide a copy of the relevant court records available from the registrar of the court concerned.
·  I certify that I am registered (or provisionally registered) as a New Zealand teacher. I solemnly and sincerely declare that to the best of my knowledge and belief the information given in this application and in my C.V. is correct.
·  I certify that the information I have supplied in this application is true and correct.
·  I certify that I know of no reason why I would not be suitable to work with children / young people.
·  I certify that I understand that, if I have supplied incorrectly or misleading information, or have omitted any important information, I may be disqualified from appointment, or if appointed, may be liable to be dismissed.
APPLICANT’S SIGNATURE: ______DATE: ______

Note: If completing this electronically, a hard copy (signed) must be provided if invited to be interviewed.

PROFESSIONAL STATEMENT AND CHRISTIAN BELIEFS:
Please provide a brief responses to the following questions (approximately 100 words)
1.  What do you consider to be your primary motive in seeking the principal position at this school? (Approximately 100 words)
2.  What do you believe is the most important function of a Seventh-day Adventist School? (Approximately 100 words)
3.  What are your views on the authority of the bible? (Approximately 100 words)
4.  What contribution would you make to the “special Seventh-day Adventist character” of the school? (Approximately 100 words)
5.  What support and guidance would you need to ensure you are able to “maintain and preserve the special character of the school”? (Approximately 100 words)
PERSONAL STATEMENT OF CHRISTIAN TESTIMONY:
Please provide a brief synopsis of your Christian walk (approximately one page).
LEARNING AND TEACHING, AND STUDENT ACHIEVEMENT: (approximately one paragraph).
1.  Describe a curriculum development you have led in your present school and the outcomes of the development on teaching and or learning.
2.  How was the effectiveness of the development measured?
CANDIDACY: (approximately one page).
1.  Summarize your reason for being a strong candidate for the position of Principal.
2.  Outline qualities of strengths that demonstrates evidence in the following areas:
proven leadership, communication building, relationships skills, managerial experience
VISION: (approximately one paragraph).
Our School Board’s strategic plans are on enrolment growth beyond current maximum enrollment (50 student) capacity and are looking at a future leader who will lead out in this exciting phase of our school.
State your vision and provide any capability experience on enrolment growth.

For Office Use only

Date Application Received:

Acknowledgement of Application Sent:

Copy forwarded to the Proprietor on: