Warrington Primary Academy Trust Teacher Job Application Form

Committed to equality at work and in our community

To be completed in black ink. All relevant sections must be completed.

A curriculum vitae must not be submitted in place of any information on this form.

1. VACANCY INFORMATION
Application for the post of
In the

This form to be returned to

by the closing date of :
Advertisement Ref. No. :	Post No :

2 PERSONAL DETAILS

Surname	Title
Previous Surname
First Name(s)	Known as
Have you ever been known by any other name? Yes No
If yes please give details
Address
Postcode
Telephone : Business	Private
Mobile Tel:	e-mail
(if shortlisted you may be invited to interview via e-mail)
Are you applying for this job as a job sharer? : Yes No
Have you previously worked for Warrington Primary Academy Trust?: Yes No
If yes, please give reason for leaving

3. RECRUITMENT MONITORING

Please indicate where you first saw or heard about the advertisement for this vacancy.

INTERNET	WBC JOBS WEBSITE	LOCAL PRESS	NATIONAL PRESS
LG JOBS	OTHER	Please state where

4. REFERENCES

Please give details of two people who are not related to you, from whom references about your suitability for the job can be obtained. If presently employed one must be your current employer. If unemployed one must be your most recent employer. In the absence of previous employment experience a reference from your headteacher / tutor or related to relevant voluntary work is acceptable.

If you are not currently working with children and/or vulnerable adults, but have done so in the past, please supply details of an additional employer by whom you were most recently employed to work with children/vulnerable adults. (This is only relevant if the job you are applying for involves working with children/vulnerable adults).

We reserve the right to request alternative references during the processing of your application.

1. Current or most recent employer	2.
Name:	Name:
Title: (Mr, Mrs etc)	Title: (Mr, Mrs etc)
Occupation:	Occupation:
Address:	Address:
Postcode:	Postcode:
Business Telephone:	Business Telephone:
Home Telephone:	Home Telephone:
Mobile:	Mobile:
E-mail:	E-mail:
How long have you known this referee and in what capacity?	How long have you known this referee and in what capacity?
Please tick this box if you do not want this referee to be contacted prior to interview.	Please tick this box if you do not want this referee to be contacted prior to interview.

After shortlisting we reserve the right to take up references. If you have indicated on your application that you do not wish us to contact the referees we will only contact the referees after interview, if you are the successful candidate.

For posts having substantial access to children the Council/school reserves the right to approach any previous employer.

5. PROFESSIONAL STATUS

Do you hold qualified teacher status (QTS)? (If yes, please give date of awarded QTS certificate number)
Yes	No	Date: dd/mm/yyyy	QTS No.:
Do you hold qualified teacher status through QTLS (awarded by the Institute for Learning) ? (If yes, please give date awarded QTLS status and reference number)
Yes	No	QTLS Ref No.:
Have you successfully completed a period of induction as a qualified teacher in this country where the Department for Education required this?
Yes	No	Date: dd/mm/yyyy
Are you subject to any conditions or prohibitions placed on you by the Department for Education (or other) in the UK?
Yes	No
If yes, please give details

6. DISCLOSURE OF RELEVANT INFORMATION (INCLUDING CRIMINAL RECORD CLEARANCE)

A criminal record will not necessarily exclude you from employment .The information provided will be treated

as strictly confidential and will only be considered in relation to the job for which you are applying.

The job for which you are applying has substantial opportunity for access to children. Your employment

is therefore exempt from the Rehabilitation of Offenders Act 1974. You will be required to complete an

Enhanced Disclosure and Barring Service (DBS) Disclosure Form. You must therefore give details of any convictions or pending prosecutions you have, even if they would otherwise be regarded as ‘spent’ under this Act. The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected' and 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 at the Disclosure and Barring Service website www.gov.uk Should you identify that you have a criminal conviction, this will be discussed in confidence at interview.

Do you have any criminal convictions, cautions, reprimands or final warnings or any pending prosecutions that you are required to declare?

Yes No

If “YES”, give details below:-

Details of offence & Sentence	Date	Court or police force who dealt with the offence

In your current, or any previous employment, have you ever been subject to any investigations or disciplinary procedures involving issues related to the safety and welfare of children, young people or vulnerable adults or your behaviour towards children, young people or vulnerable adults ?

Yes No

If “YES”, please provide details below, for example the outcome of the investigations or procedures and whether any penalties that were applied have now expired :-

Details and Date/s

Posts that may have substantial opportunity for access to children or vulnerable adults are exempt from the Rehabilitation of Offenders Act and will require a DBS check. I acknowledge that it is my responsibility as the candidate, if invited for interview, to disclose any information to the panel which may affect working with children/vulnerable adults. Failure to do so may disqualify me from appointment or result in dismissal.

7. DECLARATION OF RELATIONSHIP

Are you or your spouse related by marriage, blood or as a cohabitee to any elected member or senior officer of the council or any member of the school governing body or senior member of staff within the school?
Yes No

If you are related please give their name and state the nature of the relationship. Failure to disclose such a relationship may lead to disqualification from the recruitment process or dismissal without notice.

Name:	Relationship:

If you canvass any Member, Committee or employee of the Council about your application, you will be disqualified. This does not stop a Member or employee giving a written reference about you.

8. IMMIGRATION ASYLUM AND NATIONALITY ACT 2006

Please refer to the enclosed guidance notes before answering these questions.

Nationality at birth: Present Nationality:
Have you ever possessed any other Nationality or Citizenship?	Yes No
Are you subject to immigration control?	Yes No
If yes, do you have unrestricted entitlement to take up employment in the UK?	Yes No
Do you have or are you entitled to obtain a National Insurance Number?	Yes No
If you have answered ‘No’ to the above question, do you have the right to work in the UK and can you provide the relevant requested information to prove that this is the case?	Yes No

9. CERTIFICATION / DECLARATION

I certify that, to the best of my knowledge, all statements contained in this form are correct and I understand that should I conceal any material fact, I will, if engaged, be liable to termination of my contract of employment.

Signed:	Date: dd/mm/yyyy

Providing false information is an offence and could result in:-

the application being rejected;

Summary Dismissal if the applicant has been selected.

possible referral to the Teachers Misconduct Team or the Police, if appropriate.
(Under the Education Act 2002 the employer has this statutory duty)

All offers of employment are subject to suitable references, qualifications check, satisfactory medical clearance, DBS if relevant to post and Asylum & Immigration checks.

We must protect the public funds we handle so may use the information you have provided on this form to prevent and detect fraud. We may also share this information, for the same purposes, with other organisations which handle public funds.

We will record and hold the information given for personnel, employment, education and training purposes in accordance with the Data Protection Act 1998.

We should like to take this opportunity to thank you for your interest in the advertised post. If you have not been contacted concerning your application within 4 weeks of the closing date, please assume you have not been shortlisted for interview.

10. EQUAL OPPORTUNITIES AND MONITORING

Warrington Primary Academy Trust is an equal opportunities employer. As such we welcome applications from people of all backgrounds, irrespective of race, sex, disability, age, sexual orientation, religion or belief.

We need to carry out diversity monitoring in order to make sure our recruitment processes are fair for all and in order to meet our statutory obligations. Please help us to do this by completing this section of the form.

The information given in this section will be used for statistical purposes only and will not form part of the shortlisting or interview process.

1. Post applied for
2. Directorate / Unit
(A) White
British	Irish	Any other white background
(B) Mixed
White & Black Caribbean	White & Black African
White & Asian	Any other mixed background
(C) Asian or Asian British
Indian	Pakistani
Bangladeshi	Any other Asian background
(D) Black or Black British
Caribbean	African	Any other black background
(E) Chinese or other ethnic group
Chinese	Other
4. Are you:	Male Female
5. Do you have a disability in accordance with the definition under the Equality Act 2010? A person has a disability if s/he has a physical or mental impairment which has a substantial and long-term adverse effect on that person's ability to carry out normal day-to-day activities. Yes No
6. Are you currently employed?	Yes No
7. Date of birth	dd/mm/yyyy
8. What is your religion?	Not prepared to say
Christian	Muslim	Hindu	Jewish
Sikh	Buddhist	Other	None
9. Sexual orientation How would you describe yourself?
Heterosexual / straight	Bisexual	Gay woman / Lesbian
Gay man	Prefer not to declare

11. VACANCY DETAILS (to be completed by school)

Application for the post of
Directorate / Unit:	Advert Ref No.:
Interview Date / Time:
Interview Availability:

NOTE TO APPLICANT : In meeting our commitment to equal opportunities the decision to shortlist you for interview will only be based on the information you enter onto the following pages of your application.

12. DISABILITY AND REASONABLE ADJUSTMENTS

By answering the following questions, you will assist the Council to comply with its obligations arising from the Equality Act 2010. You are not compulsorily required to give this information. However, if you advise us that you do have a disability and you meet the essential criteria of the person specification, the Council will guarantee you an interview.

DISABILITY DEFINITION (Equality Act 2010)

"a physical or mental impairment which has a substantial and long term adverse effect on a person's ability to carry out normal day to day activities"

DO YOU HAVE A DISABILITY IN ACCORDANCE WITH THE ABOVE DEFINITION? Yes No

(regardless of whether or not it has an impact on your ability to do the job for which you are applying)

If you do have a disability or health condition, and require particular adjustments or arrangements to facilitate your participation in the selection process, please give details below.

13. INTERVIEW ATTENDANCE

Please indicate any periods when you may not be available for interview. We cannot guarantee to accommodate alternative dates.

14. EDUCATION ATTAINMENTS

Education, training and professional qualifications

FROM	TO	Full Name and Address of School / College / University / Institution	Qualifications
(Month & Year)	Gained (with grades)	For which you are studying

In-service, training and courses (for previous 3 years) as a participant or course leader.

Dates & Duration	Title of course/training	Name of Provider	Qualification (if any)

PROFESSIONAL BODIES

(Please give details of any professional body of which you are a Member. Indicate those obtained by examination)

Please note that you will be required to produce evidence of qualifications attained.

15. DRIVING LICENCE DETAILS

Do you hold a full current licence?	Yes No
If yes, what type of licence: -	Car / Light Vehicle	HGV	OTHER
Other, please provide details of the categories

Do you hold a category D1 licence which would allow you to drive a school minibus?	YES	NO

16. CURRENT EMPLOYMENT DETAILS

Title of present/most recent job:
Name & address of employer:	Date appointed:	Date left if applicable:
Age range taught:	Nos. on Roll:
Permanent or Temporary:	Part time or Full time:
Tel No.	Reason for leaving if already left:

Salary per annum £	Salary point MPS/UPS	Leadership / AST
TLR	Other Allowance: (Please specify)

17. FULL OCCUPATIONAL HISTORY

Please give details of ALL full and part-time work as well as particulars of ALL paid or unpaid employment experience e.g. commercial experience, raising a family, youth work, voluntary work or periods when you were not employed.

Please complete the columns by entering the most recent first. PLEASE DO NOT LEAVE ANY GAPS IN THIS HISTORY. (Continue on a separate sheet if necessary)

Type of experience/Post title (paid or unpaid) and reason for leaving	Name & Address of Employer	Nos on Roll	Age Range taught	Dates
From	To

18. WRITE IN SUPPORT OF YOUR APPLICATION HERE – This section must be completed

A Curriculum Vitae must not be submitted in place of any information required on this form.

You may, however, wish to submit supplementary evidence to your application form by attaching a maximum of 2 sides of A4 paper.

Please explain how you meet the requirements outlined in the Person Specification. You should give examples from previous paid, unpaid or voluntary experience.