CHURCH OF ENGLAND - DIOCESE OF SOUTHWARK TEACHING STAFF APPLICATION SOUTHWARK DIOCESAN BOARD of EDUCATION

CONFIDENTIAL NAME OF SCHOOL: Christs school

Closing date for completed form: 8am, Monday, 3rd February 2014 Return form to: Mrs C"rist%s &c"ool, Ric"mond, &urrey '(10 )*( Mylles at: amylles!c"rists#ric"mond#sc"#u$

-lease state +"ere you sa+ t"e ad.ertisement for t"is post:

to +"om all ,ueries s"ould be addressed APPLICANT!S PERSONAL DETAILS '/'01: F/R&' 2 M1: &3R2 M1:

-R14/53& 2 M1&:

-1RM 212' 66R1&&:

(5R7 '10 25: *5M1 '10 25: M58/01 -*521 25: M 9 (1 '101-*521 953 ' (5R7: 9es 2o 1M /0 66R1&&:

'1 C*1R R1F1R12C1 25:

2 '/52 0 /2&3R 2C1 25:

" TEACHER STATUS

6o you "a.e :ualified 'eac"er &tatus re t"ere any restrictions on your residence or employment in t"e 37; /f 9es, please gi.e details # SUPPORTING STATEMENT
1
&681< --'&<5ct 2010

9es

2o

(it" reference to t"e =o.ernors> selection criteria, please gi.e details of your e?perience, s$ills, abilities and personal ,ualities t"at you belie.e are rele.ant to your suitability for t"e post and indicate "o+ you meet t"e person specification# lso pro.ide any additional information +"ic" you t"in$ +ould be useful in t"is @ob# -lease +rite t"is on a separate s"eetAsB of paper#

$ PRESENT OR MOST RECENT EMPLO%MENT

2 M1 5F &C*550 26 1M-0591R:

&C*550 66R1&&:

0 '9-1 C &' '3& 5F 1&' 80/&*M12': =1 R 2=1:

R1 23M81R 5F -3-/0&:

-5&' *106:

6 '1& 5F --5/2'M12':

&C 01 -5/2' 26 -R1&12' 223 0 & 0 R9 Aincl allo+ancesB:

& PRE'IOUS TEACHING EMPLO%MENT (st)rt *ith +ost r,c,-t . /l,)s, ,0/l)i- )-1 2)/s i- ,+/lo1+,-t3 &c"ool, college or ot"er employer 'ype C status of establis"ment ge range and roll Aappro?B 'itle of post Ainclude special responsibilitiesB 6ates of employment

2
&681< --'&<5ct 2010

4 EDUCATION AND ACADEMIC 5UALIFICATIONS &c"ool<college<uni.ersity &econdary Apost 1)B From 'o &ub@ects<:ualifications<=rades<*onours, dates a+arded and a+arding body

*ig"er 1ducation

Furt"er postgraduate ,ualifications Aincluding -=C1B

6 IN-SER'ICE TRAINING UNDERTAKEN DURING THE PAST # %EARS RELE'ANT TO THIS APPLICATION

3
&681< --'&<5ct 2010

Course title

-ro.ider

6ates C duration of course

+ard Aif anyB

7 OTHER PAID WORK E8PERIENCE (/l,)s, ,0/l)i- )-1 2)/s i- ,+/lo1+,-t3 1mployer From 'o 2ature of 5ccupation

9 DETAILS OF OTHER ACTI'ITIES: SKILLS AND INTERESTS RELE'ANT TO THIS POST

4
&681< --'&<5ct 2010

; RELIGIOUS AFFILIATION

D
&681< --'&<5ct 2010

6etails of your ,ualifications and e?perience +"ic" you feel are especially rele.ant to teac"ing in a C"urc" of 1ngland sc"ool, not included in your supporting statement# ("ere appropriate, please include details of a C"ristian or ot"er fait" commitment and any centre of +ors"ip you regularly attend#

PROFESSIONAL REFERENCES - /l,)s, s<//l1 th, -)+,s )-= )==r,ss,s o> t*o /,rso-s *illi-2 to /ro?i=, r,>,r,-c,s@ O-, sho<l= A, >ro+ 1o<r c<rr,-t H,)=t,)ch,r@ I> 1o< )r, -ot c<rr,-tl1 *orBi-2 *ith chil=r,-: ) r,>,r,-c, >ro+ th, ,+/lo1,r A1 *ho+ 1o< *,r, +ost r,c,-tl1 ,+/lo1,= to *orB *ith chil=r,- *ill A, r,C<ir,=@ R,>,r,-c,s *ill -ot A, )cc,/t,= >ro+ r,l)ti?,s or /,o/l, *riti-2 sol,l1 i- th, c)/)cit1 o> >ri,-=s@ 2 M1: 66R1&&:

'10# 25:

1M /0:

-5&/'/52 *106: -lease state t"e conte?t in +"ic" t"is person is $no+n to yourself:

2 M1: 66R1&&:

'10# 25:

1M /0:

-5&/'/52 *106: -lease state t"e conte?t in +"ic" t"is person is $no+n to yourself:

)
&681< --'&<5ct 2010

" DECLARATION D% APPLICANT / understand t"at appointment to t"is post is sub@ect to a satisfactory 1n"anced Criminal Records 8ureau disclosure# / also understand t"at, under t"e terms of t"e Re"abilitation of 5ffenders ct 1EF4 A1?ceptions 5rder 1EFD, and subse,uent amendmentsB, / am re,uired to disclose any record / may "a.e of criminal con.ictions, cautions and bindGo.ers, including t"ose regarded as Hspent% and to attac" details of t"e same#I *a.e you a record of criminal con.ictions, cautions or bindGo.ers; 9es Adetails attac"edB 2o

I -lease note information about criminal con.ictions, cautions and bindGo.ers +ill remain confidential but +ill be made a.ailable to t"e panel for consideration if your application is ot"er+ise deemed +ort"y of s"ortGlisting# / declare t"at / am not on 0ist EE, or dis,ualified from +or$ing +it" c"ildren, or sub@ect to any sanctions imposed by a regulatory body Ai#e# t"e =eneral 'eac"ing CouncilB / understand t"at under t"e terms of t"e /mmigration, sylum and 2ationality ct 200)s"ould / be s"ortGlisted for t"e post for +"ic" / am applying, / +ill pro.ide for t"e go.erning body, as employer, an original documentI s"o+ing my entitlement to +or$ in t"is country#
I cceptable documents include your 2ational /nsurance card, a birt" certificate issued in t"e 37 or 1ire, a -4D from your pre.ious employer, a .alid passport, or any rele.ant aut"orisation allo+ing you to +or$ in t"is country#

/ appreciate t"at / must declare any family or close relations"ip +it" a member of t"e sc"ool>s =o.erning 8ody, an employee of t"e sc"ool or senior official of t"e local education aut"ority +"ic" "as responsibility for t"e sc"ool# / understand t"at failure to disclose suc" a relations"ip may result in my dis,ualification# / certify t"at all information gi.en by me on eac" section of t"is form and in supporting documents is correct to t"e best of my $no+ledge and belief, t"at all ,uestions "a.e been fully and accurately ans+ered, and t"at / possess all ,ualifications +"ic" / claim to "old and +ill produce e.idence of t"e same# / ac$no+ledge t"at / "a.e read, understand and +ill comply +it" t"e 2otes to pplicants +"ic" accompanied t"is application form# / understand t"at my name +ill be +it"dra+n from t"e list of candidates if, prior to appointment, / am found $no+ingly to "a.e omitted or concealed any rele.ant fact, and / ac$no+ledge t"at suc" disco.ery subse,uent to appointment is li$ely to lead to my dismissal +it"out notice and, +"ere appropriate, referral to t"e police# / "ereby consent to t"e processing of sensiti.e personal data, as defined by t"e 6ata -rotection ct 1EE8, in.ol.ed in t"e consideration of t"is application# &/=216: 6 '1:

F
&681< --'&<5ct 2010

ADDITIONAL INFORMATION (CONFIDENTIAL3 - This s,ctio- o> th, >or+ s,,Bs )==itio-)l i->or+)tio/,rti-,-t to 1o<r )//lic)tio-@ It *ill A, r,+o?,= A,>or, shortlisti-2 )-= *ill -ot A, s,,- A1 )-1 +,+A,rs o> th, s,l,ctio- /)-,l@ Acc,ss to it *ill A, li+it,= to st)>> i-?ol?,= i- )=+i-ist,ri-2 th, )//oi-t+,-t /roc,ss *ho -,,= )cc,ss >or ,C<)l o//ort<-iti,s +o-itori-2 or to t)B, )=+i-istr)ti?, )ctio- A)s,= </o- th, i->or+)tio- /ro?i=,= ,@2@ Occ</)tio-)l H,)lth r,>,rr)l Positio- )//li,= >or: 'itle: 6ate of birt": re t"ere any reasonable ad@ustments you +ould li$e us to ma$e to enable you to participate fully and fairly in t"e recruitment process; 9es /f 9es, please gi.e details: 2o First name: &urname:

8
&681< --'&<5ct 2010

E5UAL OPPORTUNITIES MONITORING - *, *ish to +o-itor co-ti-<o<sl1 (i- th, strict,st co->i=,-c,3 th, /ro2r,ss o> o<r EC<)l O//ort<-iti,s Polic1@ Pl,)s, h,l/ <s A1 2i?i-2 th, ><ll,st /ossiAl, )-s*,rs to th, C<,stio-s A,lo*@ S,0: M F A2,: 20G2E 30G3E 40G4E D0GDE )0G)D

/ consider myself to be disabled +it"in t"e meaning of t"e 6isability 6iscrimination ct 1EED Pl,)s, i-=ic)t, 1o<r c<lt<r)lE,th-ic ori2i-s '"is information is included as part of t"e duty of t"e sc"ool to promote race e,uality and to ensure e,ual opportunities for all staff and is recommended by t"e Commission for Racial 1,uality A+++#cre#go.#u$B# White 8ritis" 1nglis" &cottis" (els" 5t"er: please +rite in /ris" ny ot"er ("ite bac$ground: please +rite in Black, Black British, Black English, Black Scottish or Black Welsh Caribbean frican ny ot"er 8lac$ bac$ground: please +rite in Asian, Asian British, Asian English, Asian Scottish or Asian /ndian -a$istani 8anglades"i ny ot"er sian bac$ground: please +rite in Mixed ("ite C 8lac$ Caribbean ("ite C 8lac$ frican ("ite C sian ny ot"er Mi?ed bac$ground: please +rite in Chinese, Chinese British, Chinese English, Chinese Scottish or Chinese Welsh or other ethnic group C"inese ny ot"er bac$ground: please +rite in Prefer not to state Put a cross here if you prefer not to state your ethnic group

E
&681< --'&<5ct 2010

Not,s to )//lic)-ts 8efore signing t"is form please c"ec$ t"at e.ery section "as been completed# '"e form s"ould be returned as instructed in t"e details of t"e post# 1nclose a stamped addressed en.elope if you +is" us to ac$no+ledge your application# 9ou are reminded t"at t"is is an application form for a post in a C"urc" of 1ngland<C"urc" in (ales 4oluntary ided sc"ool or a Foundation sc"ool in +"ic" t"e =o.erning 8ody is t"e employer# /f you are appointed t"e Contract you +ill be as$ed to sign +ill include t"e follo+ing clause At"e second paragrap" is omitted in t"e case of a Foundation sc"ool or +"ere you are not re,uired to gi.e religious educationB: o s a teac"er in a C"urc" of 1ngland<C"urc" in (ales sc"ool you are re,uired to "a.e regard to t"e C"ristian c"aracter of t"e sc"ool and its Foundation and to underta$e not to do anyt"ing in any +ay contrary to t"e interests of t"e Foundation# 9ou are re,uired to gi.e and<or super.ise t"e gi.ing of religious education in accordance +it" t"e doctrines of t"e C"urc" of 1ngland<C"urc" in (ales and 'rust 6eed of t"e &c"ool# 9ou are re,uired to ta$e part in and lead acts of religious +ors"ip#

'"e successful applicant +ill be re,uired to pro.ide an 1n"anced 6isclosure from t"e CR8#

Details of referees 5ne referee s"ould be your current or most recent employer# /f you are not currently +or$ing +it" c"ildren but "a.e done so in t"e past, a reference +ill be re,uired from t"e employer by +"om you +ere most recently employed in +or$ +it" c"ildren# '"e sc"ool +ill see$ references on s"ortGlisted candidates, and may approac" pre.ious employers for information to .erify particular e?perience of ,ualifications, before t"e inter.ie+# /f you are currently +or$ing +it" c"ildren, on a paid or .oluntary basis, your current employer +ill be as$ed about disciplinary offences relating to c"ildren, including any penalty +"ic" is time e?pired and +"et"er you "a.e been t"e sub@ect of any c"ild protection concerns, and if so, t"e outcome of t"e en,uiry or disciplinary procedure# /f you are not currently +or$ing +it" c"ildren but "a.e done so in t"e past, t"e rele.ant pre.ious employer +ill be as$ed about t"ose issues# References from relati.es or friends +riting solely in t"e capacity of friends +ill not be accepted#

10
&681< --'&<5ct 2010