Address*:
Post Code: *
*One contact number is required
National Insurance Number: *
.
Post held :
Name and address of employer:
Summary of duties :
Please provide details of your previous employment including: name and address of employer, job title and brief description of duties, reason for leaving, final salary and dates of employment. Start with most recent first and work back, accounting for any breaks in employment.
Post held: Name and address of employer: Summary of duties :
Post held:
Date of commencement:
Permanent or Temporary : Please select Permanent Temporary
Post held : Name and address of employer: Summary of duties :
Additional previous employment details and information about breaks in employment:
Please provide details of date awarded, awarding organisation, qualifications gained and grades obtained
Additional Education Information
Please provide details of any relevant training or additional qualifications you have
Your Personal Statement should provide information which should relate to your past experience and to the requirements stated in the advertisement, job description and person specification as short-listing for interview is dependent on the extent to which your application matches the requirements for the position
Please state…………
Please state the level of membership, the Institution, and whether gained by examination.
Have you ever been convicted of a criminal offence? Please specify if yes:
NB. If the post you are applying for is covered by the Rehabilitation of Offenders Exemptions Order 1975, you are required to disclose any information you may have regarding any convictions, cautions and bind-overs, against yourself regardless of when they occurred (which would otherwise be considered as ‘spent’ in relation to this application). Any such information will be treated in strictest confidence and used only in consideration of the suitability of your application. (If applicable, please attach any additional details of past convictions in a sealed envelope marked confidential).
You will be required to sign this section of the application form at interview stage should you be short-listed :
I confirm that I am not on List 99, disqualified from working with children, or subject to sanctions imposed by a regulatory body, e.g., the General Teaching Council (GTC). I have no convictions, cautions or bind-overs that I have not provided information about within or as an attachment to this application. (If you are submitting your application on-line, it is confirmed that in doing so you agree to this statement).
Where appropriate the successful applicant will be required to provide a Disclosure from the CRB appropriate to the level of the post. Please refer to the College CRB policy for further details. The College also has a recruitment of ex-offenders policy, should you require further guidance. Leek College will not unfairly discriminate against the subject of Disclosure information on the basis of conviction or other details revealed. Disclosures will only be sought after a candidate has been provided with a provisional offer.
Do you have any criminal charges pending? No Yes
Have you ever been dismissed from employment for a reason other than redundancy? No Yes
Have you ever been suspended or subject to any disciplinary action? No Yes
If you have stated yes to any of the above please give details below:
If you are related or have a close relationship to an existing employee of the College (including Governers), please give details below:
Please only complete if you are applying for a teaching post at the College
Please enter your DfES reference number:
Additional Information about your teaching qualification: (Please note that it is not a legal requirement that you have QTS or are registered with the GTC to undertake a teaching position at this College)
Do you have Qualified Teacher Status (QTLS)? No Yes
Please enter your QTLS number: Please note that all teaching staff must comply with the requirements of the Further Education Teachers Qualifications (England) Regulations 2007.
Are you registered with the GTC for England? No Yes
If you have qualified teacher status please confirm which of the following student groups it qualifies to teach:
Do you hold a current driving licence? No Yes
How many days have you been absent from work in the last 12 months?
Please state the reason(s) for your absence(s) (optional):
Please supply name, address, telephone numbers and occupations of two people to whom a professional reference can be made. At least one should be your current or your most recent employer. References will not be accepted from relatives or from people writing solely in the capacity of friends. If you are not currently working with people under the age of 18 but have done so in the past, you should provide a reference from this post.
Reference 1:
Name:
Title: (Mr, Mrs, Miss, Ms, Other)
Job Title:
Work Relationship (e.g. manager, supervisor):
Address:
Postcode:
Email:
Telephone:
Reference 2:
We will seek references for all short-listed candidates prior to interview and may approach previous employers for information to verify particular experience or qualifications before interview.
Do you object to these being contacted before an interview? No Yes
Canvassing either directly or indirectly will disqualify a candidate from appointment.
This information will be used only for monitoring purposes or to identify where reasonable adjustments might need to be made and will not form part of the selection process. All information will be treated as confidential.
Ethnic Origin: I would describe my Ethnic origin as (Please select)
Bangladeshi
British
Indian
Multi-racial
Irish
Pakistani
White & Asian
Other White Background
Other Asian Background
White & Black African
Other
Black or British
White & Black Caribbean
Please give details:
African
Other Multi-Racial Background
Caribbean
Prefer not to say
Do you consider yourself to have a disability, illness or a special need for which the College may need to make special provision?
No Yes Prefer not to say
If yes, please specify the nature of the disability:
Are there any adjustments that need to be made for the purpose of:
a) the job:
b) the interview:
The College adopts a ‘Positive About Disabled People’ recruitment policy. Therefore we offer an interview to anyone who may have a disability who meets the minimum criteria required for the position. If you are an applicant with disabilities and your application is successful, every effort will be made to supply all necessary adaptations, employment aids or equipment to enable you to carry out the full duties of the job.
What is your marital status: Please select Single Married Divorced Widowed
What is your sexual orientation Please select Bisexual Lesbian or Gay Man Heterosexual Prefer not to say
In order to comply with the Asylum and Immigration Act 1996 all prospective employees will be requested to provide evidence of their eligibility to work in the UK. You will be requested to produce an official document e.g. your birth certificate or passport, or a document showing your National Insurance Number, or a current work permit. Further guidance is included within your application pack.
a) Do you require a work permit to work in the UK? No Yes
b) Is your permission to live and work in the UK time limited? No Yes If no, further information not required
c) Please provide full details of your current immigration status, renewal dates and any other relevant information.
d) Please note that the College is unable to employ anyone who does not have the right to live and work legally in the UK. Please explain the basis on which you believe you will be able to live and work in the UK legally on the commencement date of the role.
Where did you see this post advertised?
To submit your application you must agree to the three statements above I agree