Associate Staff Application

APPLICATION FOR THE POSITION OF:

Where did you see this post advertised?

Personal Details

Surname:

Title

Mr

Mrs

Miss

Ms

Other:

Forename(s):

Former names (if applicable):

Address

Telephone Number (Home):

Work:

Mobile Telephone number:

E-mail address:

National Insurance Number:

Date of Birth:

If you are not a European Citizen please state if you require a work permit:

Yes

No

Referees

These
should be persons of appropriate standing with direct knowledge of your
professional work and should include your present employer. Applicants employed in a school should
include their Headteacher as one of the referees.

Referee 1:

Referee 2:

Education/Qualifications

Please give information about all education received in the
country or abroad and qualifications obtained including degrees with class and
division and Teaching Certificates.

Secondary Schools, Colleges and Universities attended:

Continuing Education/ Training

Please give details of all courses (including the month/year) attended of at least one day over the last two years. Attach a separate sheet if required.

Present Employment

Present Job Title:

Date appointed to post:

Current Salary £:

Part Time/Job Share

Yes

No

Proportion

Notice Required:

Employer:

Employer Address:

Employer's Phone Number:

Employer's Email Address:

Key Responsibilities:

Previous Employment:

Gaps In Employment:

Supporting Statement:

Other relevant information:

Please give details of any periods of absence through illness in the last three years, together with the reason. (This section must be filled in – a nil return is required)

Safeguarding Statement

This school is committed to
safeguarding and promoting the welfare of children and young people and expects
all staff and volunteers to share this commitment.

Statement:

I understand that if I am selected for shortlisting or interview, my suitability to work with children will be explored and this will include disclosing any convictions. I declare that I am not on the BARRED List, not disqualified from work with children or subjected to sanction imposed by a regulatory body.

Agree

Disagree

Name:

Date

Declaration

Are you related to a school governor likely to be involved in this appointment?

Yes

No

If YES, please give details:

Supporting Documents (optional)