Support Staff Application Form

Post Being Applied For*

Personal Details

Title (Dr, Mrs, Mr etc) First Name* Surname* Former Names (eg. Maiden name or any previous change of name(s).* Date of Birth* Country of Birth* Nationality*

Permit to work in the UK?*YesNoN/A

Date when permit/visa expires National Insurance Number* Passport Number* Driving License Number Telephone Number* Mobile Number* Email Address* Current Address* Previous Address* Where did hear about this job from?*

Have you worked in an educational establishment before?*YesNo

Have you been subject to a DBS check before?*YesNo

Does anyone in your family currently work in an educational establishment*YesNo

Fitness To Work

Do you have a medical condition or long term illness where you may have need for adjustments to be made?*YesNo

Is this covered by the Disability Discrimination Act 1995 (DDA)?*YesNo

Education, Qualifications & Training

Academic Qualifications for the Post (Please provide the most recent first)*

	Subject & Level (eg. GCSE, A-Level, Degree or Training)	Grade Obtained	Date Obtained	Where obtained Name & Address

Employment History

Please supply a full history in chronological order (with start and end dates) of all employment, self-employment and any periods of unemployment since leaving secondary education including any unpaid or voluntary work. Provide where appropriate explanations for any periods not in employment, self-employment or further education/training and in each case the reasons for leaving employment.

Present or Most Recent Employment

Name and Address of Employer* Job Title* Salary* Date From (DD/MM/YY)* Date To (DD/MM/YY)* Period of Notice / Date Available to Start* Key Responsibilities* Reason for Seeking New Position / Leaving*

Previous Employment (Most Recent First)

Job Title and Brief Outline of Duties* Name and Address of Employer* Date From (DD/MM/YY)* Date To (DD/MM/YY)* Reason for Leaving*

Job Title and Brief Outline of Duties Name and Address of Employer Date From (DD/MM/YY)* Date To (DD/MM/YY)* Reason for Leaving*

NB. We reserve the right to contact employers or educational establishments to verify details given.

Please provide further employment history here with details of company, address, dates from -to (MM/YYYY) and reason for leaving. Please also give details and an explanation for any gaps in your employment history:*

Supporting Statement

Please read the information about the post. Using examples, show how your knowledge, skills and experience meet the criteria for this post. Please draw on your relevant experiences; including paid employment, voluntary work, family experiences and leisure activities as evidence. You may continue on a seperate sheet where necessary.* No file chosen

References

Please provide three referees. One referee should be your current or most recent employer, the second should be a previous employer and the third should be a personal character reference.

Where you are not currently working with children but have done so in the past one referee must be from the employer by whom you were most recently employed in work with children.

Please note, references will not be accepted from relatives or from referees writing solely in the capacity of friends. If short listed, references will automatically be taken up before your interview and you will be responsible for their receipt by the School at least one day before the day of interview.

If an exceptional reason exists where you do not wish your current employer to be approached before interview, a covering letter explaining the circumstances must cover your completed application form. In this situation it may be agreed that an additional reference where you have previously worked with children will be sought, until the reference from your current employer can be obtained.

Referee 1

Name* Address* Telephone Number* Email* Occupation* Referee's relationship to you* How long have they known you?*

I agree to this reference being taken up before an interview or offer of employment is made*YesNo

Referee 2

Name* Address* Telephone Number* Email* Occupation* Referee's relationship to you* How long have they known you?*

I agree to this reference being taken up before an interview or offer of employment is made*YesNo

Referee 3

Name* Address* Telephone Number* Email* Occupation* Referee's relationship to you* How long have they known you?*

I agree to this reference being taken up before an interview or offer of employment is made*YesNo

Please indicate if you know any existing employees or governors at the school, and if so how you know them*

Declaration

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 on the Disclosure and Barring Service website.

Applicants are to provide any information about unprotected criminal records in a separate sealed envelope marked ‘Confidential – Disclosure’ and attach it to this application form or addressed to the Headmaster.

1. By signing this application form you confirm that all convictions, cautions, reprimands, or final warnings, including those regarded as ‘spent’ have been declared as required by law.

2. You hereby consent for the above references to be taken up on your behalf by the school as required.

3. By signing this application form you confirm that you have read and understood the contents of the School’s Child Protection Policy found on www.morehouseschool.co.uk/child-protection.pdf

I declare that the information I have given on this application form is complete and accurate. I confirm I have not been disqualified from working with children. I am not named on DfES List 99 nor have any record that may be revealed through a Disclosure & Barring check or on any other regulatory list that would make me unsuitable to work with children.

I further confirm that I am not subject to any sanctions imposed by a regulatory body such as (for example) the General Teaching Council.*I have no convictions, cautions, reprimands, or final warnings ORI have sent details of any convictions, cautions, reprimands, or final warnings in a sealed envelope marked confidential

Signature* Date*

More House School

Support Staff Application Form

Personal Details

Fitness To Work

Education, Qualifications & Training

Employment History

Present or Most Recent Employment

Previous Employment (Most Recent First)

Supporting Statement

References

Referee 1

Referee 2

Referee 3

Declaration

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