West Park School

‘A caring school where we put pupils and their achievement first’

West Road

Spondon

Derby

DE21 7BT

Telephone:01332 662337e-mail:

Fax:01332 280767

An Equal Opportunity Employer

TEACHER APPLICATION FORM

IMPORTANT:

Please complete this form in Black ink or word process. Please complete every section.

APPLICATION FOR THE POSITION OF: ......
Personal Details
Surname: ...... Title: Mr/Mrs/Miss/Ms or other: ......
Forename(s): ……………………………………………………………………Former names (if applicable): …………………………….
Home address:......
...... Post Code: ......
Telephone Number (Home): ...... Work: ......
Mobile Telephone number: ...... E-mail address: ......
Date of Birth: ...... Teacher Reference:…………………………………………….
Current Salary as a Teacher: £ ...... (p/a) Date of Qualification as a Teacher: …………………….
National Insurance Number: ……………………………………………………………………………………………………………………………
If you are not a European Citizen please state if you require a work permit:YesNo 
Referees
Two referees are required. These should be persons of appropriate standing with direct knowledge of your professional work and should include your present employer. Applicants employed in a school should include their Headteacher as one of the referees.
Name: ……………………………………………………………………….
Job Title: …………………………………………………………………...
Address: …………………………………………………………………….
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Telephone Number: ………………………………………………….
Email address: …………………………………………………………… / Name: …………………………………………………………………………
Job Title: …………………………………………………………………….
Address: ……………………………………………………………………..
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Telephone Number: …………………………………………………..
Email address: …………………………………………………………...
Education/Qualifications
Please give information about all education received in the country or abroad and qualifications obtained including degrees with class and division and Teaching Certificates.
Secondary Schools, Colleges and Universities / Dates / To / Details of examinations passed and qualifications obtained
Age group for which trained:KS3KS4KS5
Length of compulsory probation/induction in maintained School/College and date of successful completion
Years: ………………………………..Months: ……………………………….. Date of Completion: ……………………………………………
LA where probation/induction period was completed: ………………………………………………………………………………………
Continuing Education/In-Service Training
Please give details of all courses (including the month/year) attended of at least one day over the last two years. Continue on a separate sheet if required.
Present Employment
Present Job Title: ………………………………………………………………………………………………………………………………………………..
Date appointed to post: …………………………… Current Salary £: ……………… Point on Scale/Allowance:……………….
Part time/Job Share: Yes No Proportion  Notice required: ………………………………
Name of School/College/Employer:…………………………………………………………………………………………………………………..
Type of School:………………………………………………………………………………….. LA (if applicable): …………………………….
Address:……………………………………………………………………………………………………………………………………………………………..
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Telephone Number/email address: …………………………………………………………………………………………………………………...
Key Responsibilities:…………………………………………………………………………………………………………………………………………
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Previous Teaching Employment
Post / School / Full/Part time / Salary Scale / Age Range / Subjects taught / Dates
From To
Other employment
Please give details.
Supporting Statement
Please give details of your experience, skills, abilities and any other additional information which you think would be useful in this job. Please complete on a separate page.
Other relevant information
May include any special or any needs that may require us to make a ‘reasonable adjustment’.
Please give details of any periods of absence through illness in the last three years, together with the reason. (This section must be filled in – a nil return is required)
Dates / Reason
Rehabilitation of offenders Act 1974
This school is committed to safeguarding and promoting the welfare of children and young people and expects all staff and volunteers to share this commitment. This post is exempt from the Rehabilitation of Offenders Act 1974. All convictions, cautions and bind-overs, including those regarded as ‘spent’ must be declared.
Statement:
I declare that I am not on List 99, not disqualified from work with children or subjected to sanction imposed by a regulatory body such as the General Teaching Council.
* I have no convictions, cautions or bind-overs.*Please delete as appropriate
* I attach details of my record in a sealed envelope marked ‘Confidential’.
Signature: ...... Date: ......
Declaration
Are you related to a school governor likely to be involved in this appointment? YES NO 
If YES please give details. If you ask a School Governor to use their influence to help you obtain this job you will be disqualified.