IPSWICH SCHOOL. Permanent Address. Telephone Number (land line and mobile if you have one) address

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Application for employment a IPSWICH SCHOOL Ipswich School is committed to safeguarding promoting the welfare of children young people expects all staff to share this commitment. Applicants must be willing to undergo child protection screening, including checks with past employers the Disclosure Barring Service. Having a criminal record will not necessarily be a bar to obtaining the position. The Ipswich School Policy on the recruitment of ex offenders the Code of Practice relating to the Disclosure Barring Service are available on request. Applicants are advised that in the interests of the health safety of all its pupils employees, Ipswich School operates a NO SMOKING POLICY. If you are completing by h, please make sure the form is completed in your own hwriting, all declarations are completed the form is signed by you. If you are completing the form electronically, please make sure a signed hard copy is provided to the School. PERSONAL DETAILS Surname First Name(s) Permanent Address Title (Mr/Mrs/Ms/Miss/Dr) National Insurance No Telephone Number (l line mobile if you have one) E-mail address Any former Surnames (e.g. maiden name) or First Names DRIVING LICENCE Do you hold a current valid driving licence? Yes/No Is your driving licence Provisional/Ordinary/Other (please specify) Please indicate any endorsements

EMPLOYMENT AND CAREER HISTORY Please supply a full history of work, parenting or other experience on the sheet enclosed, starting with your most recent position working backwards since leaving secondary education. Include periods of any post-secondary education/training, part-time voluntary work as well as full time employment, with start end dates; explanations for periods not in employment, education or training; salaries reasons for leaving employment. Applicants should note that in accordance with guidelines from the Department for Education (DfE) to prevent unsuitable people working with young people, Ipswich School may contact any previous employer. EDUCATION AND QUALIFICATIONS Cidates will be asked to verify qualifications relevant to the post applied for. Please continue on a separate sheet if necessary. Dates From To Name of School or College Examinations Passed/Qualifications Obtained Please give details of any other professional qualifications you hold details of any courses you have attended: VETTING: DISCLOSURE AND BARRING SERVICE Please note that if your application is successful a Disclosure will be requested from the Disclosure Barring Service. The post is exempt from the Rehabilitation of Offenders Act 1974 therefore all convictions, cautions bindovers, including those regarded as spent must be declared. Please delete one of the following statements: I do not have any criminal convictions, cautions or bindovers I attach details of criminal convictions, cautions or bindovers in a sealed envelope marked confidential

REFERENCES Normally, references will be requested for all cidates invited for interview, unless you ask us not to by indicating below. This will not affect our decision to invite you for interview; however, references will need to be taken up prior to an offer of employment being made. If you are currently working with children on either a paid or voluntary basis, your current employer with children will be asked about disciplinary offences relating to children, including any in which the penalty is time expired whether you have been the subject of any child protection concerns if so, the outcome of any enquiry or disciplinary procedure. Please give the names, addresses contact details of two people who would be willing to supply a reference about you, at least one of whom must be your most recent or current employer. Please state in what capacity they know you. Please note that references are not acceptable from relatives or from people writing solely in the capacity of friends that it is Ipswich School s policy to verify all references. Most recent or current employer Name Position Company Address Telephone number e-mail address May we contact them if you are on our interview shortlist? Yes/No If you answer no, we will contact you for permission before requesting a reference Other referee Name Position Capacity in which you know the person Address Telephone number e-mail address May we contact them if you are on our interview shortlist? Yes/No If you answer no, we will contact you for permission before requesting a reference. Note: If you are not currently working with children but have done so in the past, we will obtain a reference from that employer we will ask you to supply relevant details in order for us to do so. We may also approach previous employers, particularly where you have worked with children, for information to verify particular experience or qualifications or issues as outlined above before interview. INTERESTS Please let us know about your personal interests skills which may be relevant to this post:

SUPPORTING INFORMATION Please set out below your reasons for applying for this post, any other information in support of your application. Please continue on a separate sheet if necessary. Please state details of any special requirements you may have if you are called for interview DECLARATION I declare that: the information given on this form is true complete to the best of my knowledge belief. I am not disqualified from working with children or subject to sanctions imposed by a regulatory body I have enclosed details of any convictions, cautions or bindovers if appropriate. I know of no reason, on grounds of mental or physical health, why I should not be able to discharge the responsibilities required by this post. I underst that: providing false information is an offence could result in the application being rejected, or summary dismissal if I am selected for the post possible referral to the police. Signed Date In accordance with the Data Protection Act 1998, Ipswich School intends to use the information supplied in this form for the purpose of recruitment selection only. Your signature on this form indicates your consent to the information being kept used for Ipswich School personnel records if successful. If unsuccessful, this information will be kept for a certain period then destroyed. Please return completed form to: Mrs A Knights, HR Manager, Ipswich School, 25 Henley Road, Ipswich, Suffolk IP1 3SG Please mark the envelope Private Confidential Please tell us how you heard about this vacancy

EMPLOYMENT AND CAREER HISTORY Name Application for Employment as Dates From To Employer's Name, Address Type of Business or Name Address of School/College Position Held, Duties, Salary Reason for Leaving or Course Title Please continue overleaf if necessary

Dates From To Employer's Name, Address Type of Business or Name Address of School/College Position Held, Duties, Salary Reason for Leaving or Course Title