Position Applied For? How did you hear about this vacancy? Surname (Block Capitals) Mr/Mrs/Miss/Ms/Dr: Forename(S) (Block Capitals): Date of Birth: National Insurance No: Present Address (Block Capitals): Postcode: Mobile Phone No: Home Phone No: Work Phone No: Are you legally eligible for employment in the UK? Yes No DfE reference number (if applicable): Do you require a work permit? Yes No If yes, how long is your current work permit valid? Email Address (If Available): Please give details of secondary and further education including any A levels or equivalent vocational courses: Please give details of any higher education and equivalent courses: Please give details of any specialized training, knowledge, experiance or awards obtained. Include foreign languages indicating level and ability, membership of professional or technical institution or societies relevant to your application: Current Job Title: Employer's Name: Current salary and scale (If applicable): Employer's Address: Employed From: Employed To: Please give a brief description of current duties, responsibilities and achievements: Previous employer's name and address: Date from: Date to: Appointment held and brief description of duties / responsibilities: Reason for leaving: If there are any gaps in your employment or education history, please explain them here: Referees: Please tick here that you agree to supply the names and contact details of at least two referees who can comment on your suitability for this position. One should be your current or most recent employer. (Note: if you are not currently working with children but have done so in the past the second referee should be the employer by whom you were most recently employed in work with children. References will not be accepted from relatives or persons who only know you as a friend). Name of Referee One: Position: In what capacity do you know the referee?: Name of organization / company: Address: Email: Work Telephone Number: Moble Number: Name of Referee Two: Position: In what capacity do you know the referee?: Name of organization / company: Address: Email: Work Telephone Number: Mobile Number: Please agree that we will contact these referees if you are short-listed for this post and seek reference before interview. Also, in relation to work with children, we will seek information about any past disciplinary issues relating to children and/or child protection concerns you may have been subject to. If you have any concerns about this please contact the Headteacher on 01908 804163 to discuss the issues. Using the person specification that you have been sent with your application pack, please demonstrate using examples your suitability for the position you are applying for. Please include your reasons for applying and interest in this position. For persons who are not British or EU nationals, if you have any conditions related to your employment please give full details: Please indicate any interests or leisure activities. Include any voluntary work or membership of clubs or societies with offices held: What attracted you to apply for this appointment?: You agree the position for which you are applying involves contact with children and is exempt from the Rehabilitation of Offenders Act 1974 and all subsequent amendments (England and Wales). For these positions you are not entitled to withhold information about police cautions, bind-overs, or any criminal convictions including any that would otherwise be considered ’spent‘ under the Act. Have you ever been convicted of any offence or bound-over or given a caution? Yes/No If yes, please give details on a separate sheet and attach it to this form in a sealed envelope marked ’Confidential Disclosure’ I understand that if my application is successful I will be required to obtain a CRB disclosure at the appropriate level. This will include obtaining police clearances if I have been overseas for a period for which a CRB Disclosure is not sufficient in line with DCSF guidelines. If I am currently working with children, on either paid or voluntary basis, my current employer with children will be asked about disciplinary offences relating to children, including any in 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 I have been the subject of any child protection concerns, and if so, the outcome of any enquiry or disciplinary procedure. If I am not currently working with children but have done so in the past, that previous employer will be asked about those issues. DECLARATION – PLEASE READ CAREFULLY For the purposes of the Data Protection Act 1998, I consent to the information contained in this form and any information received by or on behalf of AAGS management relating to the subject matter of this form being processed by them in administering the recruitment process. I declare that the information I have given on this form is complete and accurate and that I am not banned or disqualified from working with children nor subject to any sanctions or conditions on my employment imposed by The Independent Safeguarding Authority, the Secretary of State or a regulatory body. I understand that to knowingly give false information, or to omit any relevant information, could result in the withdrawal of any offer of appointment, or my dismissal at any time in the future and possible criminal prosecution. Date: Signed: Print Name: Send