Please complete this form as fully as possible. Please note you must complete all sectionsin order to be considered for interview. If you are appointed, the information you provide on this document will form the basis of your personal record and will be available to senior staff at the centres.

Preferred centre / Please select No preferenceEpsom CollegeSt. George's AscotSt. John's LeatherheadRugby SchoolSevenoaks School / Where did you hear about us?
Your availability / From: dd/mm/yy / To: dd/mm/yy
1. Personal details
First name / Marital status
Surname / Nationality
Date of birth / dd/mm/yy / Mother tongue
Current correspondence address(untildd/mm/yy) / Permanent address
Postcode / Postcode
Country / Country
Tel / Tel
Mobile / Mobile
E-mail / Skype name
Do you speak other languages? If ‘Yes’, please give details with degree of fluency. Yes No
If required, do you have a valid work visa/permission to work in the UK? Yes No
(If yes, please submit a copy of it with your application).
Do you have a Disclosure and Barring Service (DBS) Certificate? YES  NO 
If YES when was it carried out?MM/YYYY
Are you on the DBS Update Service? YES  NO 
  1. Secondary Education A levels or equivalent.

School/College / Qualification/SubjectGrade / Date awarded
mm/yy
mm/yy
mm/yy
mm/yy
3.Higher Education & other qualifications including TEFL, lifeguard, First Aid, music etc. Successful applicants will be askedto produce original documentation confirming all qualifications.
Institution / Qualification/SubjectGrade / Date awarded
mm/yy
mm/yy
mm/yy
mm/yy
mm/yy
4. EFL teaching experiencein last 15 years. Please start with your most recent employment first. For teaching please state the age range. You will be required to explain any gaps at interview.
Dates (mm/yy) / Employer/Country / Levels/Ages / Hours p/wk
from / to
mm/yy / mm/yy
mm/yy / mm/yy
mm/yy / mm/yy
mm/yy / mm/yy
mm/yy / mm/yy
mm/yy / mm/yy
5. Other work experience in last 15 years including voluntary work
Dates (mm/yy) / Position / Employer
from / to
mm/yy / mm/yy
mm/yy / mm/yy
mm/yy / mm/yy
mm/yy / mm/yy
mm/yy / mm/yy
6. Recreation Activities
As part of your role, you will be expected to lead or actively supervise afternoon and evening recreation activities. Please tick those activities below that you feel enthusiastic about and able to actively and competently supervise.
Sports Activities
Aerobics / Basketball / Football / Softball / Tennis
Badminton / Climbing / Rounders / Squash / Table Tennis
Baseball / Cricket / Rugby / Swimming / Volleyball
Creative Activities
Art / Dance / ICT / Music
Craft / Drama / Juggling / Photography
If you have qualifications in any of the above, please make sure you include the details in section 3
7. Health and Safety
Working on residential summer courses can be extremely challenging. Are there any special
circumstances which may affect your ability to fulfil your duties? / Yes / No
Do you have any special health or dietary needs? / Yes / No
If ‘Yes’ to either of the above please give further details below.
All staff are expected, at appropriate times, to actively support the Housemaster or Housemistress in charge of their boarding house to ensure student welfare.
Please tick to confirm that you accept the responsibility of being a residential member of staff?
Do you have a current recognised First Aid qualification, e.g. First Aid at Work? Yes No
(If ‘Yes’, please make sure you have included details in Section 3)
8. Supporting statement- teaching Please use this space to highlight your suitability for the position applied for, including any experience of managing/supervising adults/children. Applications submitted without a supporting statement will be considered incomplete.
9. Supporting statement– recreational and pastoral Please use this space to highlight your suitability for the non-teaching aspects of the role of an EFL teacher e.g. recreational, excursion, airport and boarding house duties. Applications submitted without a supporting statement will be considered incomplete.
10. Professional referees -One of these must be your current/most recent employer. References will only be taken up after a first interview. References from friends or family or pre-written references will not be accepted. Referees will also be asked about your suitability to work with students under 18.
Referee 1 / Referee 2
Name / Name
Position / Position
Organisation / Organisation
Address / Address
Postcode / Postcode
Tel / Tel
E-mail / E-mail
11. Personal declaration
Safeguarding
Thames Valley Summer Schools is committed to safeguarding and protecting the welfare of children and young people. We expect you to share this commitment.
In the event of a successful application, an Update Service check will be performed where applicable or an Enhanced DBS Disclosure (and/or a Certificate of Good Conduct for those living overseas) will be sought and a Barred List check done. You will also be required to do a short online Safeguarding course prior to your arrival at the centre.
Any disclosures will be treated in the strictest confidence. Failure to disclose convictions will result in dismissal. Having a conviction will not automatically prevent you from working for Thames Valley Summer Schools.
Rehabilitation of Offenders Act 1974
All posts involving direct contact with vulnerable children are exempt from the Rehabilitation of Offenders Act 1974.
The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected'. These are not subject to disclosure to employers and cannot be taken into account. Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website.
Have you ever been convicted of a criminal offence which is not ‘protected’ YES NO
If you have answered yes, supply details of all convictions in a sealed envelope marked “confidential” and attach to this form. If your application is successful, this information will be checked against information from the Disclosure & Barring Service before your appointment is confirmed.
Smoking, Alcohol and Substance Abuse Policy
All our centres operate as non-smoking environments. As a member of staff, you agree to not smoke anywhere on the school site.
The consumption of alcohol and substance abuse is not permitted at any of the centres. You may consume alcohol when off duty and not at the course centre, though you must be fit to supervise students on your return.
Please tick to confirm that you agree to the Smoking, Alcohol and Substance Abuse Policy I Agree
Failure to abide by these rules will be treated as a serious disciplinary matter and could lead to immediate dismissal.
Promotional Material
I give my permission that any films or photos taken during my employment with Thames Valley Summer Schools, in which I appear, may be used for training or promotional purposes.
Data Protection
Your personal details will be recorded on our computers and paper copies will be filed. If your application is successful and you accept a contract with Thames Valley Summer Schools, the application form will be kept on your personal file. If your application is unsuccessful, this form will be kept on your file for no more than 18 months. This information may be disclosed to third parties, including the British Council, and Senior Staff at the centres. By submitting this application form you give your consent to Thames Valley Summer Schools to hold and process your information in accordance with the Data Protection Act 1998.
Section Y – Declaration
Declaration
I confirm that the above information is complete and accurate and I understand that any offer of employment is subject to:
a) references which are satisfactory to the school
b) a satisfactory DBS certificate and check of the Barred list
c) the entries on this form proving to be complete and accurate and
d) a satisfactory medical report, if appropriate.
I confirm that I have not been disqualified from working with children, cautioned or sanctioned in this regard. I have not withheld any facts or criminal conviction relevant to my application and there is no reason why I should not be considered a person suitable to work with children. I understand that any false or misleading information may be sufficient for cancellation of any agreements.
For emailed applications, please type your full name in the signature area.
Signature: Date: dd/mm/yy

Email your completed application form as an attachment to the Director of Education & Recruitment - . We aim to contact successful applicants within three working days.

Thames Valley Summer Schools is an Equal Opportunities Employer