Light Hall School

Hathaway Road
Shirley
Solihull
B90 2PZ

 0121 744 3835

HR@[Link]
HEADTEACHER: MRS A KIMBLIN

LIGHT HALL SCHOOL

Teaching Staff Appointment
Confidential
PLEASE COMPLETE THIS FORM IN BLACK INK OR TYPESCRIPT USING BLOCK LETTERS.
Separate sheets of information may be attached where necessary.
PART 1 – INFORMATION FOR SHORTLISTING AND INTERVIEWING
Position applied for:
Closing date: How did you hear of this vacancy?
(TES/TES Online/Other)

Personal Details
Surname: Forename:
Teacher Reference Number:
(Mr/Mrs/Miss/Ms) delete as applicable
Address:

DfES Reference Number:

National Insurance Number:

Superannuation Scheme: Teacher/Other please
specify

Daytime Tel Number: Current driving licence YES/NO

Evening Tel Number:
Mobile Tel Number: E-mail Address:

Present Teaching Post (if applicable)

Present post: Date appointed:

Full time/Part-time: Current Salary Scale/Grade:

Spinal Point: TLR:
Name & address of school: Name & address of local authority:

Telephone number:

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Experience – previous career and other

Please complete the following starting with your current employment and include all employment including non-teaching. Please also include any breaks in
employment history together with the reason for the break. This information may form part of your salary assessment, so please complete the following accurately
and include all experience since leaving full time education, or any other relevant experience. Your application may be returned if you leave any gaps in your
employment history

Date Salary of Reason for

current or Responsibilities (Please Leaving/Reason for
Prop.
most F/t indicate type and size of break in employment
From To Employer’s Name Employer’s Address Position Held of
recent P/t school, subjects and ages including
Mth/Yr Mth/Yr Hrs
teaching taught) resignation/compromise
position agreement

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Teaching Qualifications
Date qualification awarded: (month & year)

Main Subject/Subsidiary Subject:

Other Cross Curricular Subjects/Interests:

Date of completion of NQT Induction:

Have you passed the numeracy and literacy Skills Test?

(Newly Qualified Teachers Only)

Education and Training

Secondary/Further Education
Name of school(s) Dates attended: Qualifications gained
From To Subject Type of Grades Date
Exam

Further/Higher Education/Teacher Qualifications

Institution(s) Attended F/T Dates attended: Qualifications gained
or
P/T
From To Title & Subject Class/Div Grades Date
Obtained

Eligibility to work
Do you require a work permit to work in the UK?

Yes No

If yes, and you have one, please state Number and Expiry date:

If you are offered this post, you will be asked to provide documentary evidence of your entitlement
to work in the UK (in accordance with the Asylum and Immigration Act 1996).

Disciplinary Action
Have you ever been subject to disciplinary action by a previous employer, or is disciplinary action
currently pending?

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Yes No

If yes, please give details:

In Service Training/Professional Development (Earliest First)

Please list any course(s) which you have undertaken which are relevant to the job and/or specified
on the person specification (Please continue on a separate paper if necessary)
Date(s) Organising Body Course Title Length of Course

Membership of Professional Bodies

Name of Professional Body Membership grade Where Date

Outside Interests/Activities

Referees: If you are successful in being invited to interview, references will be taken at this time.
If you have worked with children in either a paid or voluntary capacity, please note that your
current/most recent employer, where you were employed to work with children, will be asked about
disciplinary offences relating to children, young people and vulnerable adults, any child protection
concerns and the outcomes of any enquiries or disciplinary procedures. This will include any
instances for which the penalty is time expired (where a warning could no longer be taken into
account in any new disciplinary hearing). Any relevant issues arising from references will be raised at
interview. We may also approach previous employers for information to verify relevant experience or
qualifications prior to interview.
1. Name: 2. Name:

Address: Address:

Telephone Number: Telephone Number:

Fax Number: Fax Number:
E-mail Address: E-mail Address:
Relationship to candidate: Relationship to candidate:

May references be taken up prior to interview? May references be taken up prior to interview?
YES / NO YES / NO
Are you, to your knowledge, related to any employee or governor at the school? YES/NO
Name: Position:
Relationship:
PART 2 – PERSONAL INFORMATION
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Relevant responses may be verified prior to shortlisting and/or used for administration purposes but will
not then be used for selection purposes. If you are called to interview you may be asked about the
answers you have given to questions 15 to 19 and question 14 if relevant to the job.

1. Date of birth
2. Did you qualify as a teacher Yes No
after May 1999?
If Yes, in which school was induction completed?

3. Have you ever been subject Yes No

to a child protection If YES please state separately under confidential cover the
investigation by your circumstances and the outcome including any orders or
employer or the General conditions. This will not be opened unless you are called
Teaching Council or to interview.
Independent Safeguarding
Authority?

4. Do you require sponsorship Yes No

(previously a work permit)? If YES please provide details under separate cover.
5. Are you related to or have a Yes No
close personal relationship
with any pupil, employee, or If YES give details separately under confidential cover.
governor? This will not be opened unless you are called to interview.

6.. NQTs ONLY: Numeracy

Have you provided evidence Literacy
of passing the Skills Tests?
Please tick or cross
7. Are there any special Yes No
arrangements which we can
make for you if you are If Yes please specify, (e.g. ground floor venue, sign
called for an interview and/or language, interpreter, audiotape etc).
work based assessment?

COMPULSORY DECLARATION OF ANY CONVICTIONS, CAUTIONS OR REPRIMANDS,

WARNINGS OR BIND-OVERS

If you are shortlisted you will be required to complete a “Disclosure of Criminal Record” form
and bring the completed form to interview. The information you give will be treated as
strictly confidential. Disclosure of a conviction, caution, warning or reprimand will not
automatically disqualify you from consideration. Any offence will only be taken into
consideration if it is one which would make you unsuitable for the type of work you are
applying for. However, offences relating to children may make you unsuitable since this is a
“regulated position” under the Under the Criminal Justice & Courts Services Act 2000.

DATA PROTECTION ACT 1998

The information collected on this form will be used in compliance with the Data Protection
Act 1998. By supplying information, you are giving your consent to the information being
processed for all employment purposes as defined in the Data Protection Act 1998. The
information may be disclosed, as appropriate, to the governors, to Occupational Health, to
the Teachers Pensions Agency, to the Department for Education, to pension, payroll and
personnel providers and relevant statutory bodies. You should also note that checks may be
made to verify the information provided and may also be used to prevent and/or detect
fraud. This form will be kept strictly confidential but may be photocopied and may be
transmitted electronically for use by those entitled to see the information as part of the
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recruitment process. When the recruitment process is completed, the form will be stored for
a maximum of six months then destroyed. If you are employed as a result of this recruitment
process then this application form will be retained as part of your personnel record.

NOTES

Under the Criminal Justice & Courts Services Act 2000 it is an offence for an individual who
has been disqualified from working with children to knowingly apply for, offer to do, accept,
or do any work in a ‘regulated position’. The position you are applying for is a “regulated
position”.

Canvassing, directly or indirectly, an employee or governor will disqualify the application.

Candidates recommended for appointment will be required to provide a satisfactory
Enhanced DBS certificate and complete a pre-employment medical questionnaire and may
be required to undergo a medical examination.

Providing any misleading or false information to support your application or canvassing

governors or staff directly or indirectly will disqualify you from appointment or if appointed
will render you liable to dismissal without notice.

Providing false information will result in the application being rejected, or withdrawal of any
offer of employment, or summary dismissal if you are in post, and possible referral to the
police. Please note that checks may be carried out to verify the contents of your application
form. Please complete the form in black ink or type. CVs are not accepted.

DECLARATION

I certify that, to the best of my knowledge and belief, all particulars included in my
application are correct. I understand and accept that providing false information will result
in my application being rejected or withdrawal of any offer of employment, or summary
dismissal if I am in post, and possible referral to the police. I understand and accept that the
information I have provided may be used in accordance with paragraph 13 above, and in
particular that checks may be carried out to verify the contents of my application form

_________________________________ _________________________________
Signature of Applicant Date

_________________________________
Print Name

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 PART 3 - EQUALITY AND DIVERSITY MONITORING

This section will be separated from part 1 and part 2. Collection of equality information is
solely for monitoring purposes to ensure that our policies and procedures are effective. We
also collect this data in accordance with the general and specific public sector equality duties
under the Equality Act 2010. Any data you enter onto this monitoring form will only be used
for monitoring purposes and will not be used in assessing and or scoring your application or
during the interview process. This information is kept fully confidential and access is strictly
limited in accordance with the Data Protection Act.

Name:
Job title applying for:
Date of application:

Ethnic Group
Workforce
Census Code Please tick
WBRI British English Welsh Northern Irish Scottish
WIRI Irish
White OOTH Irish Traveller
OOTH Gypsy
WOTH Other White background
MWBC White and Black Caribbean
MWBA White and Black African
Mixed MWAS White and Asian
MOTH Other Mixed background
AIND Indian
APKN Pakistani
Asian
ABAN Bangladeshi
or Asian British
CHNE Chinese
AOTH Other Asian background
BCRB Caribbean
Black BAFR African
or Black British BOTH Other Black background
Other ethnic group OOTH Arab
Write in:

Prefer not to say REFU

Religion
Please tick
No religion
Christian (including Church of England, Catholic,
Protestant and all other Christian denominations)
Buddhist
Hindu
Jewish
Muslim
Sikh
Any other religion write in
Prefer not to say
Disability
Do you consider yourself to have a disability?
Please tick

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 No
Prefer not to say

My disability is:
Sensory Impairment
Mental Health Condition
Learning Disability/ Difficulty
Long standing illness
Other
Prefer not to say

Sexual Orientation Please tick

Bi-sexual
Gay
Lesbian
Heterosexual
Other
Prefer not to say

Gender Please tick

Personal Relationship Please tick

Thank you for taking the time to complete this monitoring sheet.

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 LIGHT HALL SCHOOL

GUIDANCE FOR APPLICANTS WITH DISABILITIES

Information is requested on this job application form about disability/medical conditions you may have.

 It is important that you tell us whether you require adjustments to any part of the selection procedure
including arrangements for interview. The application form allows you to provide this information.
 If you are offered the job, any adjustments to the working conditions or environment that may be required
to enable you to carry out the duties of the job will be considered in consultation with you.

Disability is defined as follows:

a person has a disability if he/she has a physical or mental impairment that has a substantial and long term
adverse effect on his/her ability to carry out normal day-to-day activities where:

 a mental impairment is defined as an impairment resulting from or consisting of a mental illness only if the
illness is a clinically well-recognised mental illness;

 long term, means the effect of the impairment has lasted at least 12 months or is likely to last for 12
months or is likely to last for the rest of a person’s life;

 normal day-to-day activities are defined as: mobility; manual dexterity; physical co-ordination; continence;
ability to lift; carry or otherwise move everyday objects; speech; hearing or eyesight; memory or ability to
concentrate, learn or understand; perception of the risk of physical danger. NB Any disability which does
not have a substantial and long term effect on one or more of them is not considered to be a disability.

Other conditions included within the definition of disability not already outlined above are:

 a recurring condition which has recurred over more than 12 months or is likely to recur over more than 12
months;

 a progressive condition, e.g. cancer, multiple sclerosis, muscular dystrophy or HIV which has, or has had,
an effect on normal day-to-day activities;

 people with severe disfigurements, although some with deliberately acquired disfigurements will not be
covered;

 people registered as disabled under the Disabled Persons (Employment) Act 1944 on 12 January 1995 and
on the date the employment right comes into force, who will be deemed to be covered. People with a
history of disability will also have protection, even if they do not now have a disability.

Your Application

 There is no legal requirement for you to provide information about your disability on this form. However
you are encouraged to do so, particularly where you believe that the information may be relevant to the
job application.

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 LIGHT HALL SCHOOL

PROTECTION OF CHILDREN: DISCLOSURE OF CRIMINAL

BACKGROUND TO THOSE WITH ACCESS TO CHILDREN

1. The work for which you have applied or volunteered involves substantial access to children.

2. In the event of a successful application an Enhanced Disclosure will be requested.

3. Light Hall School is entitled, under arrangements introduced for the protection of children, to
check with the DBS for the existence and content of any criminal record of a successful applicant.
Information obtained from the DBS will be kept in the strictest confidence.

4. A criminal record will not necessarily debar you from working at Light Hall School. If the check
proves positive, the school will decide if the conviction is relevant to the job in question.

5. If you refuse to give your permission for a Disclosure, it will not be possible to proceed with your
application to work at Light Hall School as either an employee or volunteer.

6. Further information about the Disclosure service can be found at [Link]/crb or by

contacting the DBS information line on 0870 9090811.

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 DATA PROTECTION
FAIR PROCESSING NOTICE

All information supplied on this application form may be held and used for recruitment, selection and
employment related purposes. Specifically, personal information collected will be used to:

• Assess your suitability for the job applied for

• To verify the accuracy of information you provide
• Comply with relevant laws or regulations
• Check and verify your identity
• Produce and monitor equal opportunities statistics

Your application may be reviewed and held via paper form or electronically.

The information you provide may be shared with third party individuals or organisations working in
partnership with recruiting organisations to assist them in the recruitment process. This could include
screening and interviewing prospective employees, medical checks or background checks.

For unsuccessful candidates your data will be retained for 6 months from the time you are made
unsuccessful. Once it reaches this retention end date it will be deleted/destroyed along with any other
information gathered throughout the recruitment process.

For successful candidates, personal data captured throughout the recruitment process will be
transferred to the HR and payroll system for the purpose of creating an employee record.

Under the Data Protection Legislation, you have rights as an individual which you can exercise in
relation to the information we hold about you. You can read more about these rights here –
[Link]

Information about how we use your data can be found on the school website.

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