Teaching Staff Application Form

Before completing this form, please ensure that you have read the school's Safeguarding and Safer Recruitment Policies, as well as the relevant job description - all of which can be found at the bottom of the Vacancies page.

Section 1: Application Details

Post Applied For* Date on which you could take up appointment*

Section 2: Personal Details and Contact Information

Title* First Name (s)* Surname* Former name(s) or any other name used Home Address* Postcode* Home telephone number* Mobile phone number* E-mail address* National Insurance Number* DfES Reference Number*

Are there any restrictions on you taking up employment in the UK?*YesNo

Have you lived outside of the UK in the last 5 years?*YesNo

If you answered 'Yes' to the previous question, please provide details. We will need to obtain a police certificate of good conduct for that country.

	Details of Residence Outside of UK
Country
Date Entering
Date Leaving

If you have lived in more than one other countries outside of the UK in the last 5 years, please use the textbox below to write any additional details.

Section 3: Current Employment Details

Name of Employer* Employer's Address* Employer's Telephone Number* Number of Pupils On Roll (at current school):* Current Position at School:* Date Appointed* Local Education Authority* Annual Salary* Please indicate the age range for which you are qualified to teach:* Please indicate your specialist teaching subjects:*

	Subjects
Main
Subsidiary

Current Notice Period* Reason For Leaving*

Section 4A: All Previous Teaching Employment

Please supply a full history of all previous teaching roles undertaken.

	Role 1	Role 2	Role 3	Role 4	Role 5
Name of School
Type of School
Age Range of School
Pupils On Roll
Position Held
Age Range Taught
Start Date (mm/yy)
End Date (mm/yy)
Full Time Or Part Time Or Supply?
Reason For Leaving

Section 4B: All Non-Teaching Previous Employment

Please supply a full history in chronological order (with start and end dates) of all non-teaching related employment, self-employment and any periods of unemployment since leaving secondary education. You must provide, where appropriate explanations for any period snot in employment, self-employment or further education/training and in each case reasons for leaving employment.

	Role 1	Role 2	Role 3
Name of Employer/Organisation
Start Date (mm/yy)
End Date (mm/yy)
Position Held
Full Time or Part Time?

Please use the box below for any further jobs you have held if they will not all fit in the table above. In addition, If there are any gaps in your employment history from leaving school to your present employment (e.g. looking after children, sabbatical year), please outline the dates and details below:

Section 5A: Non QTS or Degree Educational Qualifications

Please provide details below of any School, Colleges or Universities you have attended since age 14 in chronological order (excluding QTS and Degree Qualification)

	GCSEs	A-Levels	2Any further educational qualification
Name of School or College
Start Date (mm/yyyy)
End Date (mm/yyyy)
Qualification Achieved (please include grade if given)

Section 5B: University Degree

Please supply details of your degree course.

Name of establishment attended* Start Date* Graduation/End Date* Main subject (s)* Subsidiary Subject(s) Degree Title* Qualification Achieved (BA, BSc etc.)* Grade Achieved*

Section 5C: QTS Education Qualifications

Name of establishment* Start Date* End Date* Date Qualified Teacher Status Granted:*

Section 5D: Other Professional Qualifications

Please specify any professional qualifications

	Qualification
Organising Body and Title of Course
Brief Description of Course and Dates

If you have obtained any additional educational or professional qualifications, please provide details using the text box below:

Section 6: Leisure Activities

Please note below your leisure interests, sports, hobbies etc.*

Section 7: Existing Contacts within the School

Please indicate if you know or are related to any existing employees or pupils at the school, and if so, how you know/are related to them.

	Contact
Name and Position Held at the School

Please write here if you have any additional contacts or details to note:

Section 8: Referees

Please provide the details of two or three referees.

Referee 1 should be your current or most recent employer. Two references will be taken up prior to interview.

If you do not want us to contact your current or most recent employer prior to interview, please specify a third referee.

	Referee 1	Referee 2	Referee 3 (Only required if current or most recent employer cannot be contacted prior to interview)
Full name
Job title/Relationship
Organisation
E-Mail Address
Daytime Telephone Number

Section 9: Statement in Support of Your Application

Please use the space below to write in support of your application. This should include details of your work experience and responsibilities as far as they relate to the post for which you are applying. In addition, if you have undertaken any voluntary work or pursue any hobbies or interests that may be relevant, please include details.* If you would prefer to provide a cover letter as a document, please upload it here:

The personal information collected on this form will be used for the purpose of recruitment and the selection for the role you have applied for, or other roles you may be suitable for within the school. If appointed, this form will become part of your employment record. The information will not be used for any other purpose, nor will it be disclosed to any third party. Please confirm by checking the boxes below that you give consent for your information to be used for the school’s recruitment purposes.

I am aware that the school will create digital and paper records on me during the recruitment and selection process.*Yes

I agree that, should I be successful in this application, an application will be made to the Disclosure and Barring Service on my behalf, for a criminal record check. I understand that, should the check not be to the satisfaction of the school, any offer of employment may be withdrawn or my employment terminated.*Yes

Anyone appointed to a post involving regular contact with children must be medically fit (see the Education (Health Standards [England]) Regulations 2003. It is the statutory responsibility of employers to satisfy themselves that individuals have the appropriate level of physical and mental fitness before an appointment offer is confirmed. These questions are also asked to ensure that the School is able to support candidates in the recruitment and selection process and make reasonable adjustments (working with our Occupational Health team) where necessary.

Do you have any form of disability? :*YesNo

If yes, please state nature of disability (The Equality Act defines disability as “A physical or mental impairment which has a substantial and long-term effect on a person’s ability to carry out normal day-to-day activities)

Greenfield School is committed to safeguarding and promoting the welfare of its children.

As this post involves contact with children for whom the school is responsible, extra checks are made on the background of the staff and volunteers concerned. Anyone offered employment will be subject to a check of police records as well as checks of professional standing.

Applicants are therefore required to declare the following:

• Have you been disqualified from providing childcare under the Childcare (Disqualification) Regulations 2018?
• Do you have any unspent conditional cautions or convictions under the Rehabilitation of Offenders Act 1974?
• Do you have any adult cautions (simple or conditional) or spent convictions that are not protected as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2020?
• Have you ever been involved in any professional disciplinary offences in the UK or overseas?

The amendments to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (2013 and 2020) provides that when applying for certain job and activities, certain convictions and cautions are considered “protected”. This means that they do not need to be disclosed to employers, and if they are disclosed, employers cannot take them into account. Guidance about where a conviction or caution should be disclosed can be found on the Ministry of Justice website.

I have read the above statements and*(A) I have nothing to declare(B) I have information to declare and will send details to hr@greenfield.surrey.sch.uk.

If you have selected option (B), please ensure your e-mail contains either:

i) Details of any order, determination, conviction, or other ground for disqualification
from registration under the Childcare (Disqualification) Regulations 2018, the Rehabilitation of Offenders Act 1974 or the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2020 including:
a. The date of the order, determination or conviction, or the date when the other
ground for disqualification arose;
b. Information about the body or court which made the order, determination or conviction,
and the sentence (if any) imposed;
c. A certified copy of the relevant order (in relation to an order or conviction)

and/or:

ii) Information regarding any involvement in any professional disciplinary offences (whether in the UK or overseas).

I confirm that the information given on the form is correct to the best of my knowledge and have provided any relevant information about a person who lives or works in the same household as me.*Yes

Signed:*