The Streetly Academy Vacancies

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Application Form

CONFIDENTIAL
APPLICATION FORM FOR APPOINTMENT TO A POST IN AN ACADEMY

This application must be completed in full. A CV will not be accepted as a replacement for any part of this form.

We are commited to safeguarding and promoting the welfare of children and young people and expect all staff and volunteers to share this commitment.

For non-teaching posts you can disregard the shaded boxes if these are not relevant to you.

Please return this form to the academy to which you are applying unless you are applying for a Head Teacher post where you must return it to the Chair or the Clerk to Governors. All of the information in this application form will be treated in the strictest confidence. If you have not been invited for an interview within 3 weeks of the closing date, please assume that your application has been unsuccessful on this occasion.

Equal Opportunities Statement
The Academy will afford equal opportunity in all aspects of employment, irrespective of age, disability, gender reassignment, pregnancy and maternity, race, religion or belief, sex, sexual orientation, marriage and civil partnership.

  English Academic Coach Application Form  

Personal Details:
Title:
First Name(s):
Address:
Surname/Family Name:
Telephone (Daytime):
Telephone (Mobile):
Telephone (Evening):
National Insurance Number (if you do not have an NI number please give details)
DFE Reference Number (Formerly DfES/DfEEr):
Date of Birth:
Post Code:
Email Address:

Please confirm you are happy for us to communicate with you using this email address:

Yes No


Referees - Please give details of two referees. If you are, or have recently been employed, one must be your current or last employer. If you have worked with children in the past, one of your referees must be able to make reference to your work with children. If your current or last employment was within a school, one referee must be the Head Teacher. If you are a student, one should be a senior staff member from your place of study. If you have not worked previously please name someone who has known you for at least three years. Your referees must not be a relative or a partner.

Reference 1:

Reference 2:


If you are shortlisted for interview, referees will be contacted prior to interview in line with current safer recruitment statutory guidance. We may request additional referees.


Present or Last Employment:
If you have more than one post please provide details of the most relevant post here and include your other post(s) under "Previous Employments".
Job title:

Name and Address of workplace (inc post code):

Employer Name:

Date of appointment from / to:

Salary, Point and any additional responsibility points or allowances:


No. pupils on roll:
Age Range Taught:
Type of School including Single/Mixed Sex:

Notice Period:

Date Left:

Reason for leaving / wishing to leave:

Brief description of job duties and responsibilities:


Previous Teaching / Leadership Posts:
Please list in chronological order. Be explicit about the type of school or college and the length of time that the post was held. Please give reasons and duration for any gaps when you have not been in employment.

Name of Local Authority

Name, Contact Details and type of School / College and whether single/mixed sex
Approx Number on Roll
Age Range Taught
Post Title, Grade or Scale, Full or Part Time
Dates
From - To
(month/year):
Reason for leaving

Continued...
If the above fields are not enough, please list any extra information in the box below:


Previous Employments (other than teaching):
Please include any voluntary work, giving reasons and the duration of any gaps when you have not been in employment.

Name and contact details of previous employers (show most recent first):

Salary
Name, Address and Contact Details of Employer
Dates (month/year)
From - To:
Reason for leaving

Continued...
If the above fields are not enough, please list any extra information in the box below:


Education, Training, Qualifications and Professional Memberships:
Please list in chronological order. Documentary evidence of relevant qualifications/memberships must be presented at interview. These must be originals.


Secondary, Higher and Further Education / Organising Body / Professional Association
Qualifications Achieved inc. Level and Grade
If relevant include key stage training, subject specialisms, specialist training or special studies (publications or research dissertations)
Dates (month/year)
From - To:
Full / Part Time

Continued...
If the above fields are not enough, please list any extra information in the box below:


Gaps in Employment
Please account for any gaps in employment/education in this section:


Letter of Application
In support of your application you are asked to attach a letter stating your reasons for applying for this post and including any information which you consider relevant to this application.

MAXIMUM INDIVIDUAL FILESIZE IS 2MB, YOUR FILE WILL NOT BE UPLOADED IF IT EXCEEDS THIS AMOUNT

Allowed Filetypes: .doc .pdf
Do you want to upload any files?

Yes No


Right to Work in the UK

As part of the recruitment process you will be required to provide evidence of your eligibility to work in the UK

Can you provide evidence of your legal right to work in the UK?
(You will be required to produce this document at Interview)

Answer:


Guidance for Disabled People
A disability is defined as any physical or mental impairment which has a substantial and long term adverse effect on your ability to carry out normal day to day activities. Long term means that the effect of the impairment has lasted at least twelve months, is likely to last for twelve months or is likely to last for the rest of a person's life.

It is important for you to tell us whether you require adjustments to any part of the selection procedure including arrangements for interview. If you are offered the job, any adjustments to the working conditions or environment that may be required to enable you to carry out the duties of the job will be considered in consultation with you.

Do you consider yourself to have a disability? Yes No I prefer not to disclose

If you have any special requirements in relation to your interview arrangements please give details:


Relationships

Are you, to the best of your knowledge, related to any Senior Staff or Governors at The Streetly Academy? Yes No

Name: Relationship: Position:
Any candidate who fails to disclose their relationship to any Senior Staff Member or Governor of the academy may have their application rejected. If appointed they may be subject to disciplinary actions or dismissal.

Criminal convictions – Rehabilitation of Offenders Act 1974 Exceptions Order 1975 (amended 2013):

All applicants are required to provide full details about any criminal record they may have.

The position for which you are applying involves contact with children and is exempt from the Rehabilitation of Offenders Act 1974 and all subsequent amendments (England & Wales). You are therefore required to provide details of any unspent convictions, cautions, reprimands and final warnings you may have and any unprotected spent convictions. Guidance and criteria on the filtering of cautions and convictions can be found on the Discloure and Barring Service website.

Have you ever been convicted of any offence, ben given a caution, reprimand or warning, whether in the UK or in another Country? These should exclude those defined as ‘protected’ by the Exceptions Order 1975 (2013)

If yes, please provide details on a separate sheet and attach it to this application form marked ‘Confidential Disclosure’. If your application is successful you will be required to complete a DBS check at the appropriate level.

Failure to disclose any information required of you may result in your application being rejected, disciplinary action or dismissal.

If you are a foreign national or a UK resident who has lived or worked abroad you must obtain a Certificate of Good Repute from that country(ies) Embassy in the UK. For example, if you have worked in France, you must obtain a Certificate of Good Repute from the French Embassy in the UK.


Convictions:


Prosecutions Pending:


Disqualification Order:


Government Department Lists:
Including DCSF List 99 (formerly DfES/DfEE), Department of Health (DoH) Protection of Children Act List (PoCA), or
Department of Health (DoH) Protection of Vulnerable Adults (PoVA)



Retired Teachers:

Under the Teachers Pensions Regulations those teachers who are in receipt of a pension and retired on or after 01/04/1997 on grounds of ill health cannot be employed unless you surrender your pension and are deemed fit to be employed as a teacher again.


Prohibition of Teachers

Are you subject to a prohibition order/interim prohibition order issued by the Secretary of State that would prevent you from carrying out teaching work in schools, sixth form colleges and 16-19 academies?



If yes, please provide details on a separate sheet and attach it to this application marked ‘Confidential Disclosure’.


General Teaching Council for England:

It is a legal requirement for qualified teachers teaching in a maintained school, non-maintained special school or pupil referral unit in England to be registered with the General Teaching Council for England (GTC(E)). This includes supply teachers and centrally employed teachers who spend any proportion of their time teaching in these schools.

You need to be aware that if appointed a check will be carried out by the academy with the GTC(E) to ensure that you are registered with them. The check will also cover any disciplinary sanctions that may have been imposed by the GTC(E) in respect of an individual teacher through their own disciplinary process.


Where did you see this vacancy advertised?:

Please be specific, e.g. Academy website / Walsall Jobshop / Other websites / Connections / Jobcentre Plus / Word of mouth.




Protection of your Data/Information and Consent

All of the information collected in this form is required in order to process your application for employment and it will be retained for recruitment, selection and employment related purposes.  The information may be confidentially shared with administrative and management personnel involved directly with the recruitment process within the Academy and with associated HR and Payroll services outside of the Academy in the context of your employment application. 

The Academy’s Data Officer is Adam Hughes, contact number 0121 353 2709.  You can contact him with any questions relating to our handling of your data.

Information on this form may be checked with the appropriate bodies to ensure accuracy i.e. referee’s, previous employment.  If you have shared any personal data which falls into ‘special category data’ under GDPR (e.g. race, ethnicity, religion, health, sexual orientation) this will not be shared with any third party except where a legal obligation should arise. 

This form and associated documents will be retained for the successful candidate, to form the basis of an employment record and stored safely and securely.  Unsuccessful candidate’s application forms and supporting documents will be securely destroyed after a period of 6 months.   

You have the right to withdraw your consent at any time and can do so by informing the Academy’s Data Officer that you wish to withdraw your consent. 

I have read and consent to my personal data on this form being held and utilised by the Streetly Academy for recruitment, selection and employment related purposes.



Declaration
1. The information I have given on this form is true and accurate to the best of my knowledge.
2. I have read or had explained to me and understand all the questions on this form.
3. I understand that deliberate omissions and incorrect statements could lead to my application being rejected or to my dismissal if appointed to the post.
4. I understand that evidence of my qualifications will be required during the selection interview process.
5. I understand that satisfactory references, CRB disclosure, medical clearance and evidence of the right to work
in the UK are required before any final offer of employment can be made.

Signature: Date:

All information provided on this form will be dealt with in accordance with the Data Protection Act 1984, Amended 1998. This information may be computerised and used for administrative purposes within The Streetly Academy. All personal information computerised by the Academy has to be registered and may only be used and disclosed as described in the Data Protection Register.

Please fill in the recruitment monitoring section below and then click the "Submit" button.

Recruitment Monitoring:

The Streetly Academy is committed to achieving fairness and equality in employment. We aim to ensure that unfair discrimination does not take place at any stage of employment including within the recruitment procedure. By completing this monitoring form you will be supporting the academy in meeting its commitments to review and monitor the effectiveness of the recruitment procedure and help us ensure that these procedures are open and available to everyone. This page will be detached from your application form, stored securely and confidentially and will not be taken into account when making the appointment.

Surname:

First Name(s):

Title (Optional):

Date of Birth:

Male / Female:

Location:
Post Applied For:

Nationality:
Full Time/Part Time:

 
 


What is your ethnic group?:
Choose one section from A to F, then tick the appropriate box to indicate your cultural background.

   


A.) White:
British
Irish
White other

B.) Mixed:
White and Black Caribbean
White and Black African
White and Asian
Mixed other

C.) Asian, 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 ethnic group

F.) Romany / Traveller
Irish Traveller
Romany Gypsy

Ethnicity Unknown
I prefer not to disclose

To which age band do you belong?
16-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+


The Equality Act 2010 defines disability as:
A disability is defined as any physical or mental impairment which has a substantial and long term adverse effect on your ability to carry out normal day to day activities. Long term means that the effect of the impairment has lasted at least twelve months, is likely to last for twelve months or is likely to last for the rest of the person's life.

Do you consider yourself to have a disability? Yes No I prefer not to disclose


Religion / Belief:
Christian (all denominations) Buddhist Hindu Jewish Muslim Sikh No denomination Other I prefer not to disclose



Security Code:
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Queslett Road East, Sutton Coldfield, West Midlands, B74 2EX.
Telephone: 0121 353 2709
Fax: 0121 353 0212
e-mail: postbox@streetly.walsall.sch.uk
www.thestreetlyacademy.co.uk