ST. GEORGE’S SCHOOL, HARPENDEN

HEADTEACHER APPOINTMENT

APPLICATION FORM

CONFIDENTIAL

Please complete in black ink or type within the boxes

1Personal details

Surname / Forenames
Previous name / Maiden name (if applicable)
Title / DfE No.
Address:
Post CodePost Code:
Home phone: / Email:
Work phone: / Email:
Mobile: / National Insurance no.:
Date of Birth[1]: / Religious Denomination / Faith[2]:

2Present post (if applicable)

Present post (title) / Date appointed
Point on scale
Name of School
Address
Post Code
Type of school / Age range / No. on roll
Age range taught / Notice required / Reason for leaving

3Education

Dates / Qualifications
From / To
Secondary school, college, further education
Higher education
Further post graduate study
Main teaching subjects offered / Additional subjects offered

4Teaching Status

Do you have Qualified Teacher Status (QTS)? / Yes No
QTS Certificate No. (if available): / Date of Qualification as a Teacher:
Work permit details and expiry date, if appropriate:
GTCE (or other) Membership Number, if applicable:
Are you subject to any conditions or prohibitions placed on you by the GTCE (or other) in the UK? /
YesNo
If yes, please give details:

5Teaching posts held (Please enter earliest first). If you are employed this should include details of your present post.

Name of school
or college (including location) / B
G
or
M / Number
on
roll / Age
range / Post title
Scale &
Reason for
leaving / Name of localauthority and school status / Dates

6Details of any non-teaching employmentand unpaid experience after the age of 16,in chronological order (for example family duties, voluntary work etc; including any breaks in service)

Employer / Position held / Job description / From / To

7Relevant professional development in preparation for headship

Please list he most significant features of professional development in the last five years

Title / Organising body / Duration / Dates
From / To

8 YourInterests

9Please provide a statement expanding on your relevant experienceand personal attributes. This statement should be specific to St. George’s School and address the Person Specification for the role of Headteacher. Please refer to evidence of how you have translated your vision for education into reality in your current role and how you would steer St. George’s to continuing success. Please limit yourself to two sides of A4 in Arial font size 11

10References

Please nominate up to three referees; one referee should be your present or most recent employer.

Name / Name / Name
Address
Post code / Address
Post code / Address
Post code
Telephone number
Email / Telephone number
Email / Telephone number
Email
Status / Status / Status
Relationship / Relationship / Relationship

11 Rehabilitation of Offenders Act, 1974 (Exceptions Order 1975)

Please note that applicants for teaching posts are not entitled to withhold information about past convictions, ‘spent’ or otherwise, under the terms of the above Act. The Act made a specific exception in respect of teachers in schools or establishments for further education that involves access to persons under the age of 18 as part of the employee’s normal duties.

You must disclose any past convictions at the time of your application. In the event of employment being offered and taken up, any failure to disclose such convictions is likely to result in disciplinary action by the Governing Body that may lead to dismissal. Any information should be given on a separate sheet from your application form and will be kept completely confidential.

Declaration: I have read and understood the above statement. If I have any convictions or cautions to declare I will supply written details of them, in a separate envelope marked 'private and confidential' with this application. I certify that I am not included on the Children’s Barred List or Adults’ Barred List maintained by the Independent Safeguarding Authority, that I have not been disqualified from working with children or vulnerable adults and I am not subject to any sanctions imposed by a regulated body or subject to any ongoing investigation into any matter which may bring into question my suitability for the post applied for.

Signed ………………………………..Date………………………………………

12 Disclosure and Barring Service

In the event of a successful application an Enhanced Disclosure will be sought from the Disclosure and Barring Service in relation to criminal and child protection matters. A conviction will not necessarily be a bar to obtaining employment.

Please sign here if you agree that the appropriate enquiry may be made to the Disclosure and Barring Service about the existence and content of any criminal record.

Signed ………………………………..Date………………………………………

13 Immigration, Asylum and Nationality Act 2006

In accordance with the Immigration, Asylum and Nationality Act 2006, the Governing Body will require new members of staff to provide documentary evidence that they are entitled to undertake the position applied for/have an ongoing entitlement to live and work in the United Kingdom. Therefore, on offer of and before commencing a position candidates should provide appropriate documentary evidence.

I confirm that I am legally entitled to work in the UK.

Signed ………………………………….Date…………………………………….

14 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……………………………………….

15 Close Personal Relationships

Are you a relative or partner of, or do you have a close relationship with, any employee or Governor ofSt Georges School? YES NO

If yes please state the name(s) of the person(s) and the relationship

……………………………………………………………………………………………………………….

RECRUITMENT MONITORING INFORMATION

Completion of this section will help us fulfil our general duty under the Equality Act 2010 to eliminate unlawful discrimination, to promote equality of opportunity and promote good relations between people of different racial groups, and our duty to monitor, by reference to racial group, applicants for employment and staff in post.

THE INFORMATION PROVIDED WILL BE USED FOR MONITORING AND STATISTICAL PURPOSES ONLY AND THIS SECTION WILL BE DETACHED FROM YOUR APPLICATION FORM IMMEDIATELY ON RECEIPT OF THE FORM

Post title: / School:
Last name(s): / First name(s):
Date of birth*: / Gender:MaleFemale

* The governors do not discriminate on the grounds of age

1Disability Monitoring

The Equality Act 2010, which came into force in October 2010, places specific and general statutory duties on all public authorities (e.g. local authorities; governing bodies of further and higher education institutions, colleges and universities; and governing bodies of educational established maintained by local educational authorities (including schools) to promote disability equality. In order to assist us with our statutory duties, we would be grateful if you could advise whether you have a disability. Please note that you are not obliged to disclose such information but that any information given will be used for monitoring purposes only. It will remain confidential and will not be passed to third parties.

The definition of disability is ‘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’. Some specific conditions deemed to be disabilities include HIV, cancer, multiple sclerosis and severe disfigurements.

Do you have a disability, long-term illness (mental or physical), on-going medical condition or treatment that we should be aware of?

Yes No

Please give brief details of your disability and any reasonable adjustments you anticipate we would need to make to your workplace or equipment to undertake the duties outlined in the job description or that you consider necessary to attend interview:

If you are registered disabled, please state your number:

The categories below are in line with the Equality & Human Rights Commission’s guidance.

2Ethnic origin

I would describe my ethnic group as:

1.White / 4.Asian, Asian British, Asian English, Asian Scottish or Asian Welsh
British / Bangladeshi
English / Indian
Scottish / Pakistani
Welsh / Any other Asian background (please specify)
Irish
Any other White background (please specify)
2.Black, Black British, Black English, Black Scottish or Black Welsh / 5.Chinese, Chinese British, Chinese English, Chinese Scottish or Chinese Welsh
African / Chinese
Caribbean / Any other Chinese background (please specify)
Any other Black background (please specify)
3.Mixed / 6.Other ethnic group
White & Asian / Other ethnic group
(please specify)
White & Black African
White & Black Caribbean
Any other Mixed background (please specify)

This does not form part of the selection process.

THE INFORMATION CONTAINED IN THIS FORM MAY BE HELD ON A COMPUTER FILE IN AN ANONYMOUS FORMAT

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[1] The Governing Body does not discriminate on grounds of age. Date of birth and dates are requested in line with the recommendations of Safeguarding Children: Safer Recruitment and Selection in Education Settings, DfE 1568-2005, July 2005.

2 The Governing Body may take religious denomination or faith into account for this post in accordance with the School Standards and Framework Act 1998 and the Equality Act 2010