Sir Charles Kao UTC

Sir Charles Kao UTC

Application for Employment -Private and Confidential

Please read the notes of guidance before completing the form. If you are filling out the form online, please type in the fields provided.

This form can be returned via email to or post to: The Principal, Sir Charles Kao UTC, Velizy Avenue, Harlow, Essex CM20 3EZ

POST APPLIED FOR

1. PERSONAL DETAILS (BLOCK LETTERS please)

Forename(s)
Surname
Address
Post Code / Home Tel No
Work Tel No
Mobile No
e-mail address
National Insurance No
If you are a qualified teacher, please give your DfES Ref No. and date of qualification
2.RIGHT TO WORK IN THE UK
Are you a British Citizen? YES NO
If no, please indicate your citizenship below (for details of countries under these categories, please refer to the Notes of Guidance for Completing the Application Form).
a) From the European Economic Area (EEA) and Switzerland?
b) From the European Economic Area (EEA) Accession States (A8)?
c) From any other country outside the European Economic Area? / YES NO
YES NO
YES NO
If yes to d), please indicate the type of visa/work permit you hold:
Indefinite leave to remain YES NO
Time bound leave to remain YES NO Expiry Date

3. PRESENT EMPLOYMENT

Name of employer
Address
Post Code / Job Title
Status or Grade
Date of Appointment
Full-Time Part-Time If P/T, hours per week
Permanent or Fixed Term
Annual Salary/package
Period of Notice
Type of School Age Range
Brief outline of responsibilities/duties / Reason For Leaving:

4. PREVIOUS EMPLOYMENT(most recent first) including service with H.M. Forces and unpaid employment.
Continue on a separate sheet if necessary.

Name of Employer, School
(Include age range) / From (dd/mm/yy) / To (dd/mm/yy) / Title of Post / Salary
(Inc. responsibility points) / F/T or P/T / Reason for Leaving
Breaks in Employment History
If you have had any breaks in employment since leaving school, give details of these periods and your activities during these times e.g. unemployment, raising family, voluntary work, training, long periods of sickness etc.

5. ATTAINTMENT

For your areas of responsibility, please indicate the results in the table below for your school
School/ Academy name / Percentage of pupils achieving 5A*-C (Inc. English and maths) GCSE / Percentage of A*-C GCSE grades for your classes/department (where applicable) / All pupils making expected level of progress at KS4 in English and maths (current academic year)

6. EDUCATION AND TRAINING

Training as a Teacher
Name of teacher training institution:
From: (Month/Year) / To: (Month/Year)
Qualification obtained:
Subjects, Main & Subsidiary:
Age range of pupils:
Other Special Interest:

7. SECONDARY SCHOOL EDUCATION

Name of School(s)
and nearest Town/City / From Month/ Year / To Month/ Year / Qualifications Obtained / Grade / Dates

8.FURTHER AND HIGHER EDUCATION(continue on a separate sheet if necessary)

Place of study
(University, College) / From
Month/ Year / To
Month/ Year / F/T
or P/T / Qualifications Obtained / Type of qualifications gained (Degree, Diploma etc.)
Main Subject / Subsidiary Subject(s)

9. OTHER QUALIFICATIONS(including membership of professional bodies)

Please indicate the date of any examinations taken and qualifications gained

Other Qualifications completed/Attended/Awarded
Professional Membership –Please give details of any professional body membership which you hold
Start Date / Professional Body / Membership level
Have you received training to teach or support students with special needs and/or learning difficulties?
YES NO If YES, please provide brief details

10. TRAINING AND DEVELOPMENT(continue on a separate sheet if necessary)

(a) Please give details of any further training/study tours/publications (including in-service and short courses)
Brief Description/Course Title / Date / Organising Body

11. EXTERNAL POSITIONS

Please give details of any positions of responsibility you have held in a voluntary or paid capacity, at national or local level (e.g. School Governor or Committee Member).

12. APPLICANT STATEMENT(continue on a separate sheet if necessary)

Referring to the role profile provide a supporting statement outlining your suitability for the post (see guidance below):

• Pick out those aspects of your experience or skills that are relevant to this post
• Using examples, explain how your ability, skills and knowledge match those required for the appointment
• Consider experience in previous employment and also other interests outside work, such as home, in the community or through voluntary activities
• Address your personal educational philosophy and how you would apply this

13. ADDITIONAL INFORMATION

If you are related to any current member of the UTC staff, please provide that person’s name and your relationship to them.

Name of employee

Relationship

14. REFERENCES

Please give the names, addresses and email of two employment referees who can be consulted regarding your professional abilities.
One referee should be your present employer or, if you are unemployed, your last employer.
1. / Name:
Title:
Relationship to applicant: / Address:
Email:
Telephone:
2. / Name:
Title:
Relationship to applicant: / Address:
Email:
Telephone:
Notes
(i)Referees may be contacted before any interviews. (Please state below if you do not wish them to be contacted, giving your reason)
(ii)If either of your referees knew you by another name, please give details
Where did you see the advertisement for this job?

15. DECLARATION

I certify that, to the best of my belief, the information I have entered is true and any false information provided in the event of employment being offered, will result in dismissal or disciplinary action by Harlow College.
Signed Date

Any personal data entered on this form may be held on computer files and processed in accordance with the Data Protection Act 1998 and that consent is given to the storage and use of such information for employment and monitoring purposes.

Equal Opportunities

Overview

EQUALITY AND DIVERSITY
MONITORING FORM
The UTCwishes to secure genuine equality of opportunity throughout the institution, whether required by legislation or not, in all aspects of its activities as an employer. The UTC aims to ensure that staff are employed on the basis of ability and requirements for the job and that no job applicant or employee receives less favourable treatment because of race, colour, nationality, ethnic origin, gender, marital status, disability, sexual orientation or any other grounds which are unjustifiable in terms of equality. The following information is required to enable the UTC to monitor the Equal Opportunity Policy and ensure its effectiveness. This data will be separated from any application and kept securely. It will not be seen by staff responsible for selection. Your name will not appear on any statistics provided.
The data will be used for monitoring purposes only.
Forename(s) Surname
Post applied for Current age Date of Birth
Marital status: Single Married Divorced Widowed
Other (please specify)
Preferred title: Miss Ms Mrs Mr Dr Other (please specify)
Post Code Nationality
Equality and Diversity Monitoring
Please tick the appropriate boxes below.
Asian or Asian British
Bangladeshi Chinese Indian
Pakistani Sri Lankan
Other
Black or Black British
African Caribbean
Other
Dual Heritage
White and Black African White and Asian
White and Black Caribbean
Other
White
British Other
European (please specify)
Any other ethnic group
Please specify
Faith/Religion
Buddhist Muslim Jewish
Hindu Christian Sikh
None
Other
Do not wish to disclose / Age
16 - 21 22 - 30 31 - 40
41 - 50 51 - 60 61 +
Gender
Female Male
Gender Identity
Do you live in a gender different to the one given at birth?
Yes No
Sexual Orientation
Bisexual Heterosexual
Lesbian or gay man Transgender
Do not wish to disclose
Caring Responsibilities
We understand persons with personal responsibility for the care of a child, the care of a person with an incapacitating disability and/or the care of an elderly person.
Dependents
Children under 16 How many?
Others dependents such as elderly parents or
disabled relatives
Disability
Do you consider yourself to have a disability?
Yes No Please specify
Could you please complete the attached Personal Disclosure form
PERSONAL DISCLOSURE FORM
For the purpose of the Disability Discrimination Act 1999 a disability is considered as an impairment which affects normal day to day activity and may be physical or mental, or may relate to a progressive illness/condition.
Do you have an impairment which affects normal day to day activity? YES NO
How can we support you?
We aim to support all staff in their employment and it is important that we understand what your needs are. Have you got a personal, physical, medical or emotional condition that could affect you carrying out your duties that you would like to tell us about?
This could include the fact that you are a carer or live independently. Please complete this form a accurately as possible and return to HR Services (Harlow College – working on behalf of the UTC) .
If you need any help completing this form please go to HR Services where staff will be pleased to help you.

Forename: Surname:

Date of birth: Title:

What kind of condition/personal situation/difficulty/disability would you like to tell us about?

Please tick all of the boxes which are appropriate:

Dyslexia/Other learning disability - please specify
Blind/Partially sighted
Deaf/Hearing loss
Mobility difficulties
Upper limb or back problems
Repetitive Strain Injury (RSI)
Mental health difficulty
Chronic progressive condition (e.g. MS, cancer, HIV)
Chronic recurrent condition (e.g. asthma, epilepsy)
Autism Spectrum Disorder (including Aspergers Syndrome)
Other - Please state the condition

How does this affect your everyday activities and your employment?

What reasonable adjustments would you wish to be taken into consideration?

Are you currently taking any medication relating to your disability that could impact your job? YES NO

If yes – please explain

How many days absence have you had in the last 12 months?

If more than 10 days, how many occasions of sickness absence did you have?

Would you like a support interview to discuss your needs in more detail? YES NO

We respect your confidentiality and request your permission to give details of your support needs to other members of staff including: your line manager, first aid/Health & Safety personnel and anyone else we feel should be informed. If you are happy for this information to be used to support the UTC in meeting your individual needs please sign below.

Signed: Date: