Application Form for Employment Thank you for your interest in working with us. Please complete this form in full and return to Jo Dallah via email to Dallah.j@rsaacademy.org (If you cannot do so because of disability please contact us) Please note that providing false information will result in the application being rejected, or withdrawal of any offer of employment. Please also note that checks may be carried out to verify the contents of your application form. VACANCY DETAILS (please indicate which vacancy you are applying for) Leadership (English) Please indicate where you saw this vacancy advertised TES Online West Midlands Jobs website Local Authority bulletin (please state which one) Other (please state) Initials Surname or family name PRESENT/MOST RECENT EMPLOYMENT DETAILS Name of Employer Address Date employment began Ended Job Title Salary/Wage Please give reason for leaving: Date available to begin new job:
EDUCATION SECONDARY EDUCATION & QUALIFICATIONS Name of school/college From To Qualifications gained with date HIGHER EDUCATION Name & addresses of University or College and/or University Education Department From To Qualifications obtained PROFESSIONAL COURSES ATTENDED (relevant courses attended in the last 3 years) Course Title and Brief Description Dates
GIVE BRIEF DETAILS OF DUTIES AND RESPONSIBILITIES OF YOUR PRESENT OR MOST RECENT POST: PLEASE DETAIL YOUR REASONS FOR APPLYING FOR THE POST AT THE RSA ACADEMY:
PREVIOUS EMPLOYMENT Please provide a full history in chronological order since leaving secondary education, including periods of any post-secondary education/training and part-time and voluntary work as well as full time employment, with start and end dates, explanations for periods not in employment or education/training, and reasons for leaving employment. From Month/Year To Month/Year Job Title or position Employer (name and address) Reason for Leaving Please enclose a continuation sheet if necessary
EXPERIENCE & ACTIVITIES WHICH REFLECT PERSONAL QUALITIES Please give details of any relevant experience. Include voluntary work and relevant skills which support your application. (Continue on a separate page if necessary.) HAVE YOU WORKED FOR THE RSA BEFORE? (If you have worked for us as organisation before, please state your job title and dates of employment) Please note all posts are subject to an enhanced DBS Check and proof of eligibility to work in the UK, Two References and proof of relevant qualifications. Please also note that by submitting this application form you are confirming that all the above details are correct.
Additional information This form will NOT be used for selection purposes. However, relevant contents may be verified prior to shortlisting. SECTION A YOUR DETAILS Please write or type in black ink Surname/Family Name Forename/Personal Name Previous Surname Preferred Name Home Address Postcode Telephone number where you can be contacted: e-mail address National Insurance : Daytime Evening SECTION B - PERSONAL INFORMATION 1. Are you registered with the Teaching Agency? 2. Did you qualify as a teacher after May 1999? 3. Have you ever been subject to an investigation by the General Teaching Council, Teaching Agency or DfE or placed on List 99? 4. Are you subject to any legal restrictions in respect of your employment in the UK? If yes, in which school was the induction completed? If YES, please state separately under confidential cover the circumstances and the outcome including any orders or conditions. If YES please provide details separately 5. Do you require a work permit? If YES please provide details separately 6. Do you have a current full driving licence? 7. Are you related to or have a close personal relationship with any pupil, employee, or governor? If YES, please give details separately under
8. Are there any special arrangements which we can make for you if you are called for an interview and/or work based assessment? confidential cover If YES, please specify, (eg ground floor venue, sign language, interpreter, audiotape etc.) SECTION C REFERENCES Please give here details of 2 references. The first referee should be your present or most recent employer or equivalent person. References will not be accepted from relatives or from people writing solely in the capacity of friends. Title and Name Address inc. postcode Title and Name Address inc. postcode Referee s relationship to you Referee s relationship to you Telephone Fax e-mail address: Telephone Fax e-mail address: SECTION D ETHNIC GROUP Please complete the grid below for the purpose of monitoring applicants for employment by reference to the racial groups which they belong, however, you are not obliged to do so. Please tick the relevant box: WHITE MIXED British English Welsh Scottish Irish Other white background White and Black Caribbean White and Black African White and Asian
ASIAN OR ASIAN BRITISH BLACK OR BLACK BRITISH CHINESE OTHER ETHNIC GROUP NOT STATED Other mixed background Indian Pakistani Bangladeshi Other Asian background Caribbean African Other black background Chinese SECTION E DATA PROTECTION The information collected on this form will be used in compliance with the Data Protection Act 1998. The information is collected for the purpose of administering the recruitment process. The information may be disclosed, as appropriate, to the governors, Occupational Health, Teaching Agency, Teachers Pension Agency, DfE, pension and payroll. You should also note that checks may be made to verify the information provided. Details of unsuccessful applicants will be kept on file for 6 months and then destroyed. SECTION F DECLARATION I certify that, to the best of my knowledge and belief, all information included in this application is correct. I understand and accept that providing false information will result in my application being rejected, or withdrawal of any offer of employment. I understand that checks may be carried out to verify the contents of my application form. Signature of applicant Date Print name