Application Form APPLICATION FORM We are committed to equal opportunities in employment and service delivery, and are only interested in your ability to do the job. Post Applied for * Please chooseKS1 Class TeacherKS1 Class Teacher (Yeo Valley Based)KS2 Class TeacherReception Class TeacherInstrumental and Vocal Music Teacher Personal Details Name * Name First First Last Last Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone * Email * National Insurance Number * Employment Details Please start with the most recent. School and LEA (if applicable) * Age range and number on roll : * Job title * Teacher Reference Number (TRN) * Subject and areas taught and any responsibilities: * Date from * to Salary spine point * Salary Amount * TLRs Amount SEN: Amount Recruitment and Retention payment Amount Salary safeguarding Amount (*delete as appropriate) Total Reason for leaving * plus1 Add minus1 Remove Please give details and an explanation for any gaps in your employment history: Education, Training and Development Name of Institution * Dates from * Dates to Course/subject-taken * Qualification/grade * plus1 Add minus1 Remove Details of any recent relevant professional development (non -award bearing) * Please include dates Professional membership Name of professional/ technical body * Grade of membership * plus1 Add minus1 Remove Supporting Statement * Please read the job description and person specification. Using examples, show how your knowledge, skills and experience demonstrate your suitability for the post, meet each of the essential requirements of the person specification and as many desirable requirements as possible. Please draw on your relevant experiences; including paid employment, voluntary work, family experiences and leisure activities as evidence. Additional Information Equality Act We are committed to interviewing people with a disability who meet the essential criteria of the person specification. The Equality Act defines a person as having a disability if he or she has, ‘a physical or mental impairment which has a substantial and long-term adverse effect on his or her ability to carry out normal day to day activities’. Do you have a disability? * Yes No We will make reasonable adjustments to help a person with a disability through the application and selection process and, if successful, to assist you in carrying out the duties of your job. If you require assistance, please contact us or provide details below: Right to work As required by the Immigration and Asylum Act, you will be required to provide appropriate documentary evidence of your legal right to work in the UK. If applicable you will also be required to produce your Work Permit. Do you have the legal right to work in the UK? * Yes No Do you require a work permit? * Yes No Affiliations A candidate for any appointment with the Trust who knows he or she is related or has a close relationship to any member of staff of the Trust or Governor of the School is required to disclose that relationship when submitting an application. Please note that soliciting support or information to give an unfair advantage may disqualify your application. Are you, your partner or family related, have a close relationship or have any interests (financial, professional or otherwise) to any employee of the Trust? * Yes No If yes, please provide details below: Health / Medical Details Successful applicants will be required to complete a confidential medical questionnaire and may be required to undergo a medical examination. Employment checks for the safeguarding of children We are committed to safeguarding and promoting the welfare of children and young people and expect all staff to share this commitment. As part of our commitment, we need to ensure that all potential employees satisfy our employment checks. Please note that where appropriate, shortlisted and/or potentially suitable applicants will be required to undertake further checks, including references, and will be required to provide a Disclosure from the CRB. Rehabilitation of Offenders Act This post is exempt from the Rehabilitation of Offenders Act 1974 and therefore all convictions, cautions and bind-overs, including those regarded as ‘spent’, must be declared. Please give details of any convictions, cautions and bind-overs, including those regarded as ‘spent’. If there are none please write ‘none’: DBS Children’s Barred List * Are your details included on DBS Children’s Barred List? Yes No Other Sanctions Please provide details below if you are subject to sanctions imposed by a regulatory body, e.g. the TRA. If there are none, please write ‘none’: Reference Please give details of two referees, one of whom must be your present or most recent employer. Normally no offer of employment will be made without reference to him / her. If you have not previously been employed, are in, or have just completed full-time education, one referee should be from a senior employee of the school, college or university. Friends and relatives are not acceptable referees, and open references will not be accepted. If a post requires additional references this will be detailed in the application pack. If you are shortlisted references may be taken up before an interview or offer of employment, unless you request otherwise. Name * Name First First Last Last Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone * Email * Occupation/Relationship * How long have they known you? * I agree to this reference being taken up before an interview or offer of employment being made: * Yes No plus1 Add minus1 Remove We will seek references as detailed above and may approach other previous employers for information to verify particular experiences or qualifications. We may also ask previous employers for information about disciplinary offences relating to children or young people, including any in which the penalty is ‘time expired or spent’ (that is where a warning could no longer be taken into account in any new disciplinary hearing for example) and whether the applicant has been the subject of any child protection concerns. This information is required, including that related to warnings regarded as ‘time expired or spent’ in order to ensure safe recruitment and meet our obligations to safeguard children. However, you should be aware that any disciplinary history declared will not automatically prevent or inhibit appointment and will depend on the dates and circumstances related to the disciplinary action, outcomes and the type of post being applied for. Note that you are also required to include information if you were subject to a disciplinary process but resigned before it was completed. Please provide any details below if you have ever been the subject of formal disciplinary proceedings. If there are none, please write ‘none’: Declaration I declare that the information given in this application is, to the best of my knowledge, complete and accurate and that it may be used for purposes registered by Cornerstone Academy Trust under the General Data Protection Regulation (GDPR) and Data Protection Act 2018. I understand that if, after appointment, any information is found to be inaccurate, this may lead to disciplinary action that may result in dismissal without notice and possible referral to the police. Signature * signature keyboard Clear Date * Submit Save Application Progress If you are human, leave this field blank. Δ