Application Form for Employment Thank you for your interest in working with us. Please complete this form in full and return to Jo Dallah via email to
[email protected] (If you cannot do so because of disability please contact us) Please note that providing false information will result in the application being rejected, or withdrawal of any offer of employment. Please also note that checks may be carried out to verify the contents of your application form.
VACANCY DETAILS (please indicate which vacancy you are applying for) Leadership (English)
Please indicate where you saw this vacancy advertised TES Online
West Midlands Jobs website
Local Authority bulletin (please state which one) ___________________________________________ Other (please state) _________________________________________________________________
Initials ____________________
Surname or family name ____________________________________
PRESENT/MOST RECENT EMPLOYMENT DETAILS Name of Employer Address Date employment began
Ended
Job Title
Salary/Wage £
Please give reason for leaving: Date available to begin new job:
EDUCATION SECONDARY EDUCATION & QUALIFICATIONS
Name of school/College
HIGHER EDUCATION Name & addresses of University or College and/or University Education Department
From
To
From
To
Qualifications gained with date
Qualifications obtained
PROFESSIONAL COURSES ATTENDED (relevant courses attended in the last 3 years) Course Title and Brief Description
Dates
GIVE BRIEF DETAILS OF DUTIES AND RESPONSIBILITIES OF YOUR PRESENT OR MOST RECENT POST:
PLEASE DETAIL YOUR REASONS FOR APPLYING FOR THE POST AT THE RSA ACADEMY:
PREVIOUS EMPLOYMENT Please provide a full history in chronological order since leaving secondary education, including periods of any post-secondary education/training and part-time and voluntary work as well as full time employment, with start and end dates, explanations for periods not in employment or education/training, and reasons for leaving employment. From To Job Title or position Employer (name Reason for Month/Year Month/Year and address) Leaving
Please enclose a continuation sheet if necessary
EXPERIENCE & ACTIVITIES WHICH REFLECT PERSONAL QUALITIES Please give details of any relevant experience. Include voluntary work and relevant skills which support your application. (Continue on a separate page if necessary.)
HAVE YOU WORKED FOR THE RSA BEFORE? (If you have worked for us as organisation before, please state your job title and dates of employment)
Please note all posts are subject to an enhanced DBS Check and proof of eligibility to work in the UK, Two References and proof of relevant qualifications. Please also note that by submitting this application form you are confirming that all the above details are correct.
Additional information This form will NOT be used for selection purposes. However, relevant contents may be verified prior to shortlisting. SECTION A YOUR DETAILS – Please write or type in black ink Surname/Family Name
Previous Surname
Forename/Personal Name
Preferred Name
Home Address Postcode Telephone number where you can be contacted:
Daytime
Evening
e-mail address National Insurance No:
SECTION B - PERSONAL INFORMATION 1. Are you registered with the Teaching Agency?
Yes
No
2. Did you qualify as a teacher after May 1999?
Yes
No
If yes, in which school was the induction completed? 3. Have you ever been subject to an investigation by the General Teaching Council, Teaching Agency or DfE or placed on List 99?
Yes
4. Are you subject to any legal restrictions in respect of your employment in the UK?
Yes
No
If YES, please state separately under confidential cover the circumstances and the outcome including any orders or conditions. No
If YES please provide details separately 5. Do you require a work permit?
Yes
No
If YES please provide details separately 6. Do you have a current full driving licence?
Yes
No
7. Are you related to or have a close personal relationship with any pupil, employee, or governor?
Yes
No
If YES, please give details separately under
8. Are there any special arrangements which we can make for you if you are called for an interview and/or work based assessment?
confidential cover Yes
No
If YES, please specify, (eg ground floor venue, sign language, interpreter, audiotape etc.)
SECTION C – REFERENCES Please give here details of 2 references. The first referee should be your present or most recent employer or equivalent person. References will not be accepted from relatives or from people writing solely in the capacity of friends.
Title and Name
Title and Name
Address inc. postcode
Address inc. postcode
Referee’s relationship to you
Referee’s relationship to you
Telephone No
Telephone No
Fax No
Fax No
e-mail address:
e-mail address:
SECTION D – ETHNIC GROUP Please complete the grid below for the purpose of monitoring applicants for employment by reference to the racial groups which they belong, however, you are not obliged to do so. Please tick the relevant box: WHITE
MIXED
British English Welsh Scottish Irish Other white background White and Black Caribbean White and Black African White and Asian
ASIAN OR ASIAN BRITISH
BLACK OR BLACK BRITISH
CHINESE OTHER ETHNIC GROUP NOT STATED
Other mixed background Indian Pakistani Bangladeshi Other Asian background Caribbean African Other black background Chinese
SECTION E – DATA PROTECTION The information collected on this form will be used in compliance with the Data Protection Act 1998. The information is collected for the purpose of administering the recruitment process. The information may be disclosed, as appropriate, to the governors, Occupational Health, Teaching Agency, Teachers Pension Agency, DfE, pension and payroll. You should also note that checks may be made to verify the information provided. Details of unsuccessful applicants will be kept on file for 6 months and then destroyed. SECTION F – DECLARATION I certify that, to the best of my knowledge and belief, all information included in this application is correct. I understand and accept that providing false information will result in my application being rejected, or withdrawal of any offer of employment. I understand that checks may be carried out to verify the contents of my application form. Signature of applicant ______________________ Print name
_______________________
Date ________________