Application form
Details of Post Applied For:
Name of School:
Position Applied For:
Job Reference Number:
Personal Details:
Title: Last Name:
First Name: Middle Name
:
Address:
Contact Number:
Email Address:
Are you eligible to work
in the United Kingdom?
The below section is only
to be completed by
teaching staff:
DfE/TRN Registration No:
Do you hold Qualified Are you a Newly
Teacher Status (QTS)? Qualified Teacher (NQT)?
Certificate Number: Date it was awarded:
Have you completed a Route by which you
period of induction obtained it:
where this was required
by DfE?
Do you hold Qualified Date of completion:
Teacher Status Learning
and skills (QTLS)?
Certificate Number: Date it was awarded:
Have you completed a Route by which you
period of induction obtained it:
where this was required
by DfE?
Please confirm your employment details starting with your most recent employment.
Application form
Most recent employment:
Title of post:
From: To:
Responsibilities and
achievements:
Employer Name:
Employer address details:
Name of local authority (if
applicable):
Salary:
Notice period:
Reason for Leaving:
Referee name:
Referee email address:
May we contact your
referee prior to interview?
Previous employment:
Title of post:
From: To:
Responsibilities and
achievements:
Employer Name:
Application form
Employer address details:
Name of local authority (if
applicable):
Salary:
Reason for Leaving:
Referee name:
Referee email address:
May we contact your
referee prior to interview?
Previous employment:
Title of post:
From: To:
Responsibilities and
achievements:
Employer Name:
Employer address details:
Name of local authority (if
applicable):
Salary:
Reason for Leaving:
Referee name:
Referee email address:
May we contact your
referee prior to interview?
Continue employment history on another sheet if applicable.
Application form
Gaps in employment:
Please provide details of any gaps in employment
Application form
From: To:
Reason:
Education and Qualifications:
Qualification: Subject(s):
Name of institution: Grade:
From: To:
Qualification: Subject(s):
Name of institution: Grade:
From: To:
Professional development. Please outline any other relevant courses / professional development:
Name of course / Subject(s):
qualification:
Name of institution: Grade:
From: To:
Membership of Professional bodies (where applicable):
Name of professional Membership status:
body:
Member number: Renewal date:
Supporting statement:
Please outline any experience, knowledge or skills you have, in addition to your employment
history that would support your application. Please refer to the person specification for the post
when completing this section.
Declaration of criminal convictions:
This section must be completed by all applicants. The information disclosed will only be shared
Application form
with those who have a need to know in order to assess suitability.
This post is exempt from the Rehabilitation of Offenders 1974 and the successful applicant will be
required to apply for an enhanced DBS certificate. As the post will involve regulated activity with
children, it is a criminal offence to apply for this post if you are included on the children’s barred
list held by the DBS.
Amendments to the Exceptions Order 1975 (2013 & 2020) 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 Ministry of Justice website by contacting DBS service.
Shortlisted candidates will be asked to provide details of all unspent convictions and those that
would not be filtered, prior to the date of the interview. You will be asked for further information
about your criminal history during the recruitment process. If your application is successful, this
self-disclosure information will be checked against information from the Disclosure & Barring
Service before your appointment is confirmed.
We recognise the contribution that ex-offenders can make as employees and volunteers and
welcome applications from them. A person’s criminal record will not, in itself, debar that person
from being appointed to this post. Any information given will be treated in the strictest
confidence. Suitable applicants will not be refused posts because of offences which are not
relevant to, and do not place them at or make them a risk in, the role for which they are applying.
All cases will be examined on an individual basis and will take the following into consideration:
· Whether the conviction is relevant to the position applied for.
· The seriousness of any offence revealed.
· The age of the applicant at the time of the offence(s).
· The length of time since the offence(s) occurred.
· Whether the applicant has a pattern of offending behaviour.
· The circumstances surrounding the offence(s), and the explanation(s) offered by the person
· Whether the applicant's circumstances have changed since the offending behaviour.
Please be aware that failure to disclose all convictions, cautions, reprimands or final warnings that
are not protected could result in any offer of employment being withdrawn or, if appointed,
disciplinary action which may result in dismissal.
Do you have any unspent conditional cautions or convictions under the Rehabilitation of
Offenders Act 1974? (Y/N)?
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? (Y/N)?
Have you ever been disqualified from working with children or vulnerable adults?
Application form
It is a criminal offence for barred individuals to seek, or to undertake, work with children.
If you have answered ‘YES’ to either of the above and are called to interview, please provide
further details on a separate sheet in a sealed envelope marked ‘CONFIDENTIAL’.
Declaration of relationships:
Are you related to or have a close personal relationship with any elected member or senior
officer of the Local authority, County Council or Group Board or a member of staff or
governor of the appointing establishment?
If yes, please provide his/her name and role, and state your relationship:
Equality Act 2010:
The Equality Act 2010 protects people with disabilities from unlawful discrimination. If you tell us
that you have a disability we will make reasonable adjustments to your working environment and
to your work arrangements and practices, if it is reasonable for us to do so.
Do you consider yourself to have a disability?
If yes, please describe your disability:
If you are invited to an interview and you
believe that we should make reasonable
adjustments for you please describe what will
be required:
General Data Protection Regulations 2018
Please contact the employing organisation to view their privacy notice in line with the new
General Data Protection Regulations 2018. Please note that the employing organisation are
responsible for providing this to you at the point of you submitting your application form.
Declaration of information:
I declare that the information I have given on this form and any other accompanying documents
is correct.
I understand that any omissions or false or misleading information provided on this form could
result in my appointment being rejected or, in the event of employment, may result in disciplinary
action being taken up to and including summary dismissal. It could also result in a referral to the
police.
I understand my application form will be retained on file and give my consent for the personal
data supplied to be used for the purposes of recruitment and selection.
Applicant signature:
Application form
Date:
