JOB APPLICATION FORM

POST TITLE:
CLOSING DATE:

1. Personal details

Mr/Miss/Ms/Mrs	Are you applying for a job share? Yes / No
Surname/Last Name:	First Names:
Address:	Telephone Number (Home):
Telephone Number (Business):
Telephone Number (Mobile):
Email:
Post Code:	N.I. No:	For Teaching posts DfE Teacher No: Qualified Teacher Status (QTS) held Y/N
Where did you see or hear of this job?

2. Educational / Technical / Professional Qualifications

Please name any institute or professional body in full, rather than using initials. If you are shortlisted you will be required to present certificates which correspond to the desirable/essential qualifications related to the post

Where attained	Subjects / Qualifications	Year	Grade

3. Details of relevant training courses

Course subject and provider	Length of course	Year

4. Employment history

Please give details of all jobs held including part time and unpaid work, starting with your present / last employer.

Employer (Name & Full Address)	Jobs held and main duties	From	To	Salary/ Grade	Reason for leaving

5. Relevant Knowledge, Experience & Skills

Please tell us how your knowledge, experience and skills meet the job requirements described in the job description and person specification, including your suitability to work with children. Please attach your supporting statement on A4 sheets.

6. Final Section

Do you hold a current driving licence? Yes / No Is it a Full / Provisional / LGV / PCV licence?
If you are a person with a disability is there anything we need to know in order to offer you a fair selection interview? For example, please let us know if you need wheelchair access, a sign language interpreter, etc.
All candidates for employment must state in writing whether they are the parent, grandparent, partner, child, stepchild, adopted child, grandchild, brother, sister, uncle, aunt, nephew or niece of an existing Trustee or employee of The St Lawrence Academy. Are you related to an existing Trustee or employee of the Academy as described above? Yes / No If yes, please provide the following details: Surname/Last Name: First Names: Address: Relationship:
Please indicate two people who can provide references, one of whom must be your present/last employer. If your present/last employment does not involve working with children but you have done so in the past, either paid or unpaid, the second referee should be from a person in your most recent position working with children.
Name: Address: Contact Tel. No. Email address: Occupation: Relationship: Please note this reference will be taken up prior to interview for all shortlisted candidates.	Name: Address: Contact Tel. No Email address: Occupation: Relationship: Please note this reference will be taken up prior to interview for all shortlisted candidates.
Additional references may be required to cover the previous 5 years. Please indicate additional people who can provide references if required. These will only be undertaken for successful candidates.
Name Address: Contact Tel. No. Email address: Occupation: Relationship:	Name: Address: Contact Tel. No. Email address: Occupation: Relationship

Have you worked or lived abroad for at least 3 months in the previous 5 years?* Yes / No *If “yes” you will be required to undertake an overseas criminal check in addition to a DBS check

Are there any restrictions to your residence in the UK which might affect your right to take up employment with the Academy? Yes / No
If Yes, please provide details:
If you are successful in your application, would you require a work permit prior to taking up employment? Yes / No
Applicants should note that failure to declare any restrictions to employment or the need for a work permit could lead to termination of service.
I declare that the information I have given is accurate and true and I am not on the ‘Children’s barred list’, disqualified from working with children, or subject to any sanctions imposed by a regulatory body (e.g. the DfE), and have no convictions, cautions or bind overs, or have attached details of my record in accordance with the declaration of criminal offences on the following page. Signed: Date:
Please return your completed application form to: Mrs L Johnson, Office and Finance Manager, The St Lawrence Academy, Doncaster Road, Scunthorpe, DN15 7DF. by email to: ljohnson@tsla.co.uk
If you have not heard from us within two weeks of the closing date you may conclude that you have not been shortlisted.

Personal Details

Data Protection Statement

The information that you provide on this form and that obtained from other relevant sources will be used to process your application for employment with The St Lawrence Academy. The personal information that you give us will also be used in a confidential manner to help us monitor our recruitment process.

If you succeed in your application and take up employment with the Academy, the information will be used in the administration of your employment with us and to provide you with information about the Academy or third party via your payslip. We may also use the information if there is a complaint or legal challenge relevant to this recruitment process.

We may check the information collected, with third parties or with other information held by us. We may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in other ways as permitted by law.

By signing the application form it will be assumed by the Academy that you agree to the processing of sensitive personal data, (as described above), in accordance with the Academy’s registration with the Data Protection Commissioner.

Declaration of Criminal Offences

The job for which you are applying involves substantial opportunity for access to children. It is therefore exempt from the Rehabilitation of Offenders Act 1974. You are therefore required to declare any convictions or cautions you may have, even if they would otherwise be regarded as "spent" under this Act. The information you give will be treated in confidence and will only be taken into account in relation to an application where the exemption applies. As the occupant of the post will have substantial access to children, a disclosure request will be made of the Disclosure Barring Service (DBS) to ascertain whether their records reveal any criminal convictions (including spent ones) relating to the successful applicant. All information given will be treated in the strictest confidence and will be used for this job application only. The disclosure of a criminal record will not debar you from appointment unless the selection panel considers that the conviction renders you unsuitable for appointment. In making this decision the panel will consider the nature of the offence, how long ago and what age you were when it was committed and any other factors which may be relevant.

Failure to declare a conviction may, however, disqualify you from appointment, or result in summary dismissal if the discrepancy comes to light.

Please detail the following, if applicable and attach on a separate attachment marked confidential, or attach in a separate sealed envelope;

Details of offence(s)

Place and date of Judgement(s)

Sentence(s)

Any other relevant information/explanation(s)

Equal Opportunities Monitoring

To help us check that we are employing people fairly, please mark the appropriate sections below.

Female	Male	Date of Birth

Do you consider your ethnic origin to be:
White	Mixed	Black
British	White and Black Caribbean	Black British
Irish	White and Black African	Caribbean
Any other white background	White and Asian	African
Any other mixed background	Any other black background
Asian	Any other ethnic group
Asian British	Chinese / Vietnamese
Indian	Cypriot Greek
Pakistani	Cypriot Turkish
Bangladeshi	Cypriot Other
Any other Asian Background	Any other ethnic group
Do you consider yourself to have a disability:
Yes / No
If yes, please state nature of disability:
The Equality Act defines disability as “A physical or mental impairment that has a ‘substantial’ and ‘long-term’ adverse effect on your ability to carry out normal daily activities”

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