ALL FIELDS ARE MANDATORY.

Surname: Forename (s):
Title: Previous surname (s):
Age: Date of Birth:
Correspondence Address: Home Telephone:
Work Telephone:
May we contact you? Yes No
Postcode: Mobile:
Email Address:
Passport No: National Insurance No:
Bank Name: Branch:
Account No: Sort Code:
Upload image:
Key Stage:1 (5-7) 2 (7-11) 3 (11-14) 4 (14-16)
Subjects:
Geographical Areas of Work: Date Available From:
Days Available: M T W T F Long/Short Term:
Non-Preferred School(s): Own Transport? Yes No

Employment History

PRESENT OR MOST RECENT EMPLOYMENT
Name & Address of Employer: Job Title and Summary of Main Duties:
Name of Business:
Date of Appointment: Are you eligible to work in the UK? Yes No
Reasons for leaving (if applicable): Do you have a valid work permit? Yes No
Nearest public transport/station:
Date of leaving: Basic Salary Scale and Current Salary:
Notice required: Current Daily Supply Rate:
PREVIOUS NON-TEACHING EMPLOYMENT
Please summarise your employment history since leaving full-time education, paid or unpaid, or working in a voluntary organisation or agency, full or part-time. Start with the most recent. Please continue on a seperate sheet if necessary. Click here for more space
Employer's Name
and Address
From
Month/Year
To
Month/Year
Job Title and Summary
of Main Duties
Reasons
for Leaving

Teaching Experience

Qualified Teaching Staff only.

LAST 3 POSTS ONLY
L.E.A Name of School
or College
Type of School
or College
Number
on Roll
Status Exact Dates of Service
Full or
Part
Time
Qualified
or
Unqualified
Salary
Scale
From To
D M Y D M Y

Supply Agency Work

Agency School/Nursery Contact Qualified
or
Unqualified
Daily
Rate
Exact Dates of Service
From To
D M Y D M Y

Qualifications and Training

EDUCATIONAL AND ACADEMIC QUALIFICATIONS (Secondary, Further/Higher or work-based)
Please give details of your education with examination dates, results and qualifications obtained. Please include any training and membership of professional bodies, relevant to this application. (Please continue on a seperate sheet if necessary). Evidence of qualifications will be requested. Click here for more space
School, College, University Examination, Course
(with dates)
From To Result/Qualifications
Gained
IN-SERVICE TRAINING Give details of the most recent, relevant courses attended and indicate any awards earned. Click here for more space
Course Title Provider Duration Dates

Strengths and Weaknesses

YOUR STRENGTHS AND WEAKNESSES
Strengths Weaknesses

Please give details of any gaps in your employment history?

Are you registered with the General Teaching Council? Yes No
DFES Reference No: Date Issued:
Date of Satisfactory Completion of Induction:
Name of Confirming Authority:

References

Give details of two people who have knowledge of you in a working environment, paid or unpaid. The first reference should be your present or most recent employer. If you are a student give appropriate school or college referees. It is the normal practice for references to be obtained before any formal interview.
If you were known to either of your referees by another name please give details:

Can references be taken prior to interview:

Your first referee:Yes No





Your second referee:Yes No
1.
Name:
2.
Name:
Position: Position:
Address: Address:
Tel: Fax: Tel: Fax:
Email: Email:
In what capacity does the above know you? In what capacity does the above know you?

Additional Information

1. If you have a disability please let us know of any special arrangements you may need to make:
2. Where did you see the advertisement for this post?
3. If seen on the internet, which site?
4. How many working days have you lost due to sickness absense over the past twelve months?

Next of Kin Information

Give details of two people whom we can contact if necessary.
1.
Name:
2.
Name:
Relationship: Relationship:
Address: Address:
Tel (Home): Mob: Tel (Home): Mob:

Equal Opportunites

This agency (Teach) is striving to achieve equal oportunities. Teach affirms its policy to uphold education programmes that ensure:

a. racial and cultural differences are respected.
b. the rights of all groups are protected.
c. equality of opportunity for all.
d. the elimination of all practice which discriminates unfairly between sexes.

Teach is also concerned for the rights of pupils with special needs and wishes to ensure that they are treated to the same opportunities as those without.

Teach requires all locum teachers to be fully aware of the implications of equal opportunities. Should you be unsure of any aspect of the above please ask your consultant to explain that to you in more detail.

Teach wishes to make clear to locum teachers that it is illegal in this country to have any form of physical contact with children in the form of discipline: this includes hitting, pushing, pulling etc.

It is a condition of inclusion on your register that you comply with the spirit of Equal Opportunities and that you do not implement any form of physical discipline.

Criminal Convictions

As a teacher/instructor any criminal convictions you may have may not be treated as 'spent' under the Rehabilitation of Offenders Act 1974. You are therefore required to declare all criminal convictions or cautions. The information given will be treated in confidence and only taken into account where the offence is relevant to the post for which you are applying. Failure to declare a conviction may require us to exclude you from our register if the offence is not declared and later comes to light. Unless you are able to provide an original copy of your CRB Clearance form provided by a Local education Authority, the agency will need to carry out a CRB check to ensure that you do not have any record that would affect your suitability to work with children. I hereby certify that all information given by me on this form is correct to the best of my knowledge, that all questions relating to me have been accurately and fully answered, and that I possess all the qualifications which I claim to hold, and I hereby give teach permission to undertake a CRB on my behalf at the current cost which I shall bear. I understand that refusal could prevent further consideration of my application.

Do you have any criminal offences?Yes No (tick as appropriate)

If you answer yes, you will be required to provide written details of any convictions, cautions, bind-overs or prosecutions pending should you be selected for interview. Please ensure that you bring these with you to your interview, if you are shortlisted.

Signed: Date:

Declaration

I agree that any offer of employment with Teach is subject to satisfactory evidence of the right to work in the UK, satisfactory references and medical clearance. In accordance with the 1998 Data Protection Act, it is agreed that Teach may hold and use personal information about me for personnel reasons and to enable the organisation to keep in touch with me. This information can be stored in both manual or computer form, including the data in Section 2 of the Data Protection Act 1998.

I confirm that the information given in this application and any attachments is factually correct and complete and I understand that any false information may, in the event of employment, result in dismissal or disciplinary action.

Signed: Date:

Thank you for your interest in working for Teach.

If you wish to email your application form please send it to info@teach.ac.com

Interviewer's Comments (Office Use Only)

Interviewed by: Signed: Date: