Confidential Identifying No: Teacher Job Application Form Part 1 Please complete all sections of the form using black ink or type. The outside pages of this application form (which contain all your personal details and the equal opportunities information) will be detached prior to shortlisting. This ensures that your application is dealt with objectively. The application form must be fully completed and CVs will not be considered.
Data Protection Act Information from this form will be processed in accordance with the Data Protection Act 1998. In signing it you agree to this data being held and processed and if appointed to the job you also agree to further personal information, including sensitive data (e.g. bank details, medicals, etc) being held and processed by Cheshire West and Chester Council in accordance with the Act.
Vacancy Information
Application for the post of Name of School/Unit/Service
Personal Details
First Name: Known as: Surname: NI Number: Preferred Title: Previous Surname(s): Address for correspondence: Post Code: DCSF No.: GTC Reg No (if applicable): Are you applying for this vacancy as a job sharer?: Yes No
Telephone Numbers
Home: Work: E-mail address:
For office use only
Return to: By: Vacancy No:
References
Please give the names of two persons who are able to comment on your suitability for this post. One must be your present or last headteacher or employer*. (For applications for headteacher posts a reference will be sought from your present local authority or employer). The employing body reserves the right to seek any further references it deems appropriate. Please let your referees know that you have quoted them as a referee and to expect a request for a reference should you be shortlisted.
Present/most recent employer* Name: Relationship to Applicant: Address: Post Code: Business Phone No: Home Phone No: E-mail:	Previous employer/other Name: Relationship to Applicant: Address: Post Code: Business Phone No: Home Phone No: E-mail:
If the referee knows you by a different last name please state: *If you have not previously been employed, please provide details of another referee.
Please tick the relevant box if you do not want us to contact your referees without your prior agreement. My present/most recent employer My previous employer/other referee

Recruitment Monitoring
Please indicate where you first saw the advertisement for this vacancy (if a newspaper, please state which one):

Confidential Identifying No: Teacher Job Application Form Part 2 This section of form to be detached prior to short listing. Vacancy Details
Application for the post of: Vacancy No. Name of School/Unit/Service: Surname: Initials:
Educational Attainments
Training and Professional Qualifications since leaving School
From To	Full name and town of College/University	Qualifications gained (including grades) or for which you are studying
Month & Year
Please note that you will be required to produce relevant evidence of qualifications attained.
Driving Licence Details
Do you have a valid driving licence? YES NO
Current Employment Details
Title of present/most recent post:
Name, address and type of school/establishment:
Telephone No:	Name of LA/employing body:
Date appointed:	Date left:
Age range taught:	Number on roll:
Permanent/temporary:	Part/full time:
Salary details (please given details of all allowances) :
Current salary:	Spinal Point:

Previous Employment
(Please enter most recent first) please explain any gaps in your employment
Title of post/type of experience	Name and address of employer	Numbers on roll	Age range taught	Dates
From	To

In-Service Education
Please give details of In-Service Education relevant to your application and undertaken in the last three years.
As a Participant
Dates of Course	Length of Course	Course Title	Qualification obtained and date of Award	Course Provider
From	To
As a Course Leader
Dates of Course	Length of Course	Course Title and brief outline of your contribution
From	To
Additional Teaching Skills and Special Interests
Please list additional teaching skills and special interests relevant to this application.
Letter of Application
You are required to submit a letter of application in which you should explain why you are applying for the job. Please concentrate on how your experience, training and personal qualities match the requirements of the job description and person specification.
Relationship to Councillors, Governors of the School or Employees
If you have any personal relationship to any Councillor, Member of a Committee, Panel or other group or employee of Cheshire West and Chester Council or Governor of the School, please give their name and relationship. This does not stop a Councillor, Governor or employee giving a reference. (Any approach to Councillors, Governors or other employees to influence a selection decision will disqualify you.) If Councillor or Governor: Name Relationship If Employee: Name Relationship Work Location Their present job
Diversity
We are committed to equality of opportunity for everyone. To assess whether our Diversity policy is effective we need to monitor it and to do this we need the information requested below. We can then compare the success rates of different groups at both the shortlisting and appointment stages to ensure that unfair discrimination is not taking place This will also enable us to comply with our obligations under current legislation. The information below will be used only for monitoring purposes and not in the selection process. Please tick correct boxes: Do you describe yourself as? Male Female Is your gender identity the same as the gender assigned to you at birth? Yes No Do you currently live and work in the gender role opposite to that assigned to you at Birth? Yes No Marital Status: Married Civil Partnership Single Date of Birth: Age: Please indicate your ethnic origin White: Mixed: Asian White British Mixed White/Black Caribbean Indian White Irish Mixed White/Black African Pakistani Any other White Mixed White/Asian Bangladeshi Other Mixed Other Asian Black or Black British: Other: Black Caribbean Chinese Black African Gypsy/Traveller Other Black Other Nationality ( Please State) How would you define your sexual orientation? Bisexual Gay Heterosexual Lesbian Prefer not to say What is your religious belief?
Disability The Disability Discrimination Act of 1995 made it unlawful for employers to discriminate against their employees who are disabled, and places a duty on the employer to make reasonable adjustments to enable the employee to undertake the work. The definition in the Act is “People with disabilities are individuals who have, or have had, a physical or mental impairment which has a substantial and long term effect on his or her ability to carry out normal day to day activities”. If you do consider yourself to be disabled under the definition in the Act, please indicate this, even if you do not currently need any adjustments to undertake your job. Do you consider yourself to have a disability? Yes No
The Rehabilitation of Offenders Act
The Rehabilitation of Offenders Act allows for a person who has been convicted of a criminal offence involving a sentence of not more than 2½ years imprisonment and who has since lived trouble free for a specified period of time (related to the severity of the offence) to be treated as if the offence, conviction or sentence had never occurred. This is known as a spent conviction. The job for which you are applying is one of those to which the provisions of the above Act in relation to spent convictions, do not apply. You must therefore disclose whether you have any previous convictions, whether or not they are spent. Should you identify that you have a criminal conviction, this will be discussed in confidence at interview. However you should note that only convictions that are relevant to the job in question will be taken into account. Do you have any criminal convictions whether spent or unspent? Yes No If yes please give further information: If you do not disclose any conviction you have it could lead to your application being rejected, or, if you are appointed, may lead later to your dismissal. If between the completion of this application form and taking up a job within Cheshire West and Chester Council, you are convicted of a criminal offence you must inform the Cheshire West and Chester Council of this. People who have convictions will be treated fairly and given every opportunity to establish their suitability for the job. All applicants will be considered on merit and ability. Any information that you give will be kept in strict confidence and will be used only in respect of your application for the job. Criminal Record Bureau Successful applicants will be asked to apply for a Criminal Record Check (Disclosure) from the Criminal Records Bureau. A copy of the Criminal Records Bureau Code of Practice is available on request. Further information about the Disclosure process can be found at www.disclosure.gov.uk

General Teaching Council (GTC)

Have you been referred to the GTC on misconduct grounds and/or are subject to a reprimand and/or a conditional registration order?	Yes	No

If yes please state:

I certify that the details on this application form and any supplementary information attached are true as far as I know. I understand that if I give false information or withhold relevant information, it could result in my dismissal. Signed: Date:

SH1406