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Application Form

Position for which you are applying

Preferred Title

Full Name

Home Address

Telephone Number

Date of Birth

National Insurance Number

Teacher Ref Number (if applicable)

Details of Present or Last Employment

Details of Previous Employment

Reason for leaving

Reason for gap in employment (if applicable)

Details of Previous Employment

Reason for leaving

Reason for gap in employment (if applicable)

Details of Previous Employment

Reason for leaving

Reason for gap in employment (if applicable)

Details of Education

Training

Membership of relevant bodies

Supporting Statement

Please indicate any family or close relationship to existing employees or employers (including Governors)

Name of First Referee

Job Title

Telephone Number

Email Address

Relationship to candidate

Please indicate your agreement for us to contact

Yes No

Name of Second Referee

Job Title

Telephone Number

Email Address

Relationship to candidate

Is this a professional or personal reference?

Please indicate your agreement for us to contact

Yes No

NCW undertakes to interview disabled people who meet the minimum / essential criteria detailed on the person specification. For these purposes, disability is defined as any physical or mental impairment which has a substantial and long term (over 12 months) adverse effect on your ability to carry out normal day to day activities. Please confirm, therefore, whether you have a disability

Yes No

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. By signing this application, the applicant confirms they are not on List 99, disqualified from working with children, or subject to sanctions imposed by a regulatory body, eg General Teaching Council (GTC), and have no convictions, cautions or bind-overs, or have attached details of such records in a sealed envelope marked confidential. NCW will seek references on short-listed candidates, and may approach previous employers for information to verify particular experience or qualification, before interview. If the applicant is currently working with children, on either a paid or voluntary basis, their current employer will be asked about disciplinary offences relating to children, including any for which the penalty is time expired (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, and if so, the outcome of any enquiry or disciplinary procedure. If the applicant is not currently working with children, but has done so in the past, that previous employer will be asked about those issues. To provide false information is an offence and could result in the application being rejected or summary dismissal if the application has been selected, and possible referral to the police.

I confirm that the details in this application are correct and complete.

Date agreed

All applications will be acknowledged by email.

Only shortlisted candidates will be contacted after the closing date.

If you have any queries or would like an application form in an alternative format, please contact Sheila Wood.

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