1. Healthcare

Employment Application Form
APPLICATION FOR THE POST OF:
Please type, or use a black ink pen. This form will be photocopied.
PERSONAL DETAILS (Block capitals)
FORENAME:
SURNAME:
TITLE:
HOME ADDRESS:
POSTCODE:
ADDRESS FOR CORRESPONDENCE (if different):
POSTCODE:
TELEPHONE NUMBER (inc. STD code):
DAYTIME:
EVENING:
MOBILE:
EMAIL ADDRESS:
DfE NUMBER:
If you do not have a DfE Number, have you applied for Qualified Teacher Status? YES/NO
NAME UNDER WHICH YOU QUALIFIED AS A TEACHER
(if different from above):
N.I. NUMBER:
Do you contribute to the Teacher’s Superannuation Scheme,
or intend to do so? YES/NO
REFERENCES
Please give the names, addresses and telephone numbers of two referees, one of whom should
be your present or most recent employer. References are usually requested in advance of
interviews.
Name:
Address:
Postcode:
Telephone No:
Email:
Reference 2:
Name:
Address:
Postcode:
Telephone No:
Email:
Please attach a supporting letter of application. It should not be more than 2 sides of A4 in length,
in which you should summarise your relevant professional achievements and provide evidence of
.
your ambition for our new school.
PLEASE NOTE THAT WE WILL CONTACT YOUR REFEREES IF SELECTED FOR INTERVIEW.
EDUCATION AND PROFESSIONAL TRAINING
SECONDARY EDUCATION
(Name of School/College)
DATE
QUALIFICATIONS
GCE O-Level/CSE/GCSE
(include grades for Maths
and English)
A,A-S,S-Level (with grades)
HIGHER EDUCATION
(Name of Institution)
DATE
QUALIFICATIONS
OCCUPATIONAL TRAINING
Please give brief details about any relevant courses and in-service training you have undertaken
in the last five years. If you are applying for a first teaching post, you may wish to outline relevant
details about your course.
Dates and
Duration of Course
Course Title / Content
Organising Body
CURRENT POST
Title of present post:
Date of appointment:
Pay scale position:
Annual salary:
Name of LEA or Company:
Name and address of present school:
Postcode:
Telephone Number (inc. STD Code):
Type of school (e.g., comprehensive, mixed, etc):
Number on roll:
Number in Sixth Form (if appropriate):
Brief summary of key responsibilities and subjects taught:
PREVIOUS EMPLOYMENT
Please list your previous teaching posts in reverse chronological order. If you are applying for a
first teaching post, list teaching practice schools, with subjects taught in the ‘Post Held’ section.
Name of Institution
No. On Roll
Post Held
Dates (inc.
Month & Year)
Please give details of any employment outside teaching, and any relevant voluntary work.
Employer
OTHER INTERESTS
Dates
Type of Work