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SAFEGUARDING PLUS ONLINE APPLICATION
YOUR DETAILS (Please fill in each space)
You must complete where there is an asterisk *.
Surname *
Mr/Mrs/Miss/Ms
Ms
Miss
Mrs
Mr
First name(s) *
Present Address *
Telephone No. *
Mobile No. *
Email *
Date of Birth (required by the NCTL and List 99) *
DfE Teacher Number (Write NONE if one) *
N.I. No. *
If Non-EEC Expiry Date of Work Permit
UK/EEC Passport *
Yes
No
Origin of Passport if non-UK/EEC
Next of Kin
Qualifications
Safeguarding Teachers
138 Sydenham Rd, London SE26 5JZ
0208 778 9944 / [email protected]
1
ALL PREVIOUS EMPLOYMENTS
All previous employment (in chronological order):
CURRENT
EMPLOYER
JOBS HELD & MAIN
DUTIES
FROM
dd/MM/YYYY
TO
dd/MM/YYYY
SALARY
REASON FOR
LEAVING
If you have any other previous employment, please add full details here including dates:
Safeguarding Teachers
138 Sydenham Rd, London SE26 5JZ
0208 778 9944 / [email protected]
2
PROFESSIONAL QUALIFICATIONS (including courses taken. e.g. Child Protection)
NAME & ADDRESS OF
COLLEGE
FROM
dd/MM/YYYY
TO
dd/MM/YYYY
QUALIFICATION
ACHIEVED
AGE RANGE
If you have any other qualifications, please add them here:
Safeguarding Teachers
138 Sydenham Rd, London SE26 5JZ
0208 778 9944 / [email protected]
3
EDUCATION HISTORY (please list your education attainments, highest qualification first.Write NONE if NONE.)
SCHOOL/COLLEGE/
UNIVERSITY
FROM
dd/MM/YYYY
TO
dd/MM/YYYY
SUBJECTS
STUDIED
LEVEL OF
QUALIFICATION
(e.g. Degree, A Levels,
GCSE, etc)
DATE
ACHIEVED
If you have any other education history, please add here:
Safeguarding Teachers
138 Sydenham Rd, London SE26 5JZ
0208 778 9944 / [email protected]
4
OTHER COURSES OR QUALIFICATIONS
SCHOOL/COLLEGE/
UNIVERSITY
FROM
dd/MM/YYYY
TO
dd/MM/YYYY
SUBJECTS
STUDIED
LEVEL OF
QUALIFICATION
(e.g. Degree, A Levels,
GCSE, etc)
DATE
ACHIEVED
If you have any other courses or qualifications, please add here:
Safeguarding Teachers
138 Sydenham Rd, London SE26 5JZ
0208 778 9944 / [email protected]
5
SPECIAL EDUCATIONAL NEEDS
S.E.N. Mainstream
S.L.D.
M.L.D.
E.B.D.
Hearing impaired/mainstream
Sign Language
AVAILABILITY
When can you start? (Please give a date) *
Yes
Car owner *
Days available *
No
Monday
Tuesday
Wednesday
Thursday
Friday
All week
How much notice do you require for booking? *
TEACHING PREFERENCES
Age range you are able to teach.
Foundation
Please number in order of preference
K.S.1
K.S.2
Secondary
Safeguarding Teachers
138 Sydenham Rd, London SE26 5JZ
0208 778 9944 / [email protected]
6
REFERENCES (Important please fill in)
Please give the names of referees. These must be professional references. One must be your recent employer. If
you are newly qualified, one reference must be from your course tutor and one must be your teaching practice. Do
not leave this section blank.The name of the referees need to cover a period of 2 years.
Please NOTE: you may need to provide more than two references as a 2 year cover is required.
NAME
JOB TITLE
ADDRESS
DATES FROM / TO
References will be taken up before registration with Safeguarding Teachers.
PLEASE TICK WICH APPLIES
Are you aware of any health condition or disability which might affect your work and which might require special
adjustments to your work or at your place of work? *
Yes
No
If yes, please provide details
Safeguarding Teachers
138 Sydenham Rd, London SE26 5JZ
0208 778 9944 / [email protected]
7
DECLARATION OF CRIMINAL RECORD
BECAUSE OF THE NATURE OF THE WORK WHICH YOU ARE APPLYING, THIS POST IS EXEMPT FROM
THE PROVISIONS OF SECTION 4 (2) OF THE REHABILITATION OF OFFENDERS ACT 1974 (EXCEPTIONS)
ORDER 1975. YOU ARE THEREFORE REQUIRED TO GIVE INFORMATION ABOUT CONVICTIONS WHICH,
FOR OTHER PURPOSES ARE DESCRIBED AS SPENT UNDER THE PROVISIONS OF THE ACT.
HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENCE; WHETHER ‘SPENT’ OR ‘UNSPENT’, AS
DEFINED IN THE REHABILITATION OF OFFENDERS ACT 1974 OR DO YOU HAVE ANY CHARGE PENDING
WHICH COULD NOT BE FILTERED IN LINE WITH CURRENT GUIDANCE? *
Yes
No
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216089/rehabilitation-offenders.pdf
SAFEGUARDING TEACHERS REQUIRES A CONFIDENTIAL CHECKING PROCEDURE WITH THE POLICE IN
ACCORDANCE WITH HOME OFFICE GUIDELINES. IF YOU HAVE BEEN CONVICTED OF A CRIMINAL OFFENCE
PLEASE GIVE FULL DETAILS ON A SEPARATE PIECE OF PAPER AND ATTACH TO THE APPLICATION FORM.
SAFEGUARDING TEACHERS CHECKS ALL APPLICANTS AGAINST LIST 99 WITH THE DEPARTMENT FOR
EDUCATION. SAFEGUARDING TEACHERS USES THE NEW CHECKING AND VETTING PROCEDURES 2010.
PLEASE DECLARE IF YOU ARE CURRENTLY BEING INVESTIGATED REGARDING ANY ALLEGED INCIDENT. * Yes
No
DECLARATION OF CANDIDATE
I HEREBY CERTIFY THAT ALL THE INFORMATION GIVEN 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 AM ENTITLED
TO THE CERTIFICATES WHICH I CLAIM TO HOLD. I HAVE LEFT NO BLANK SPACES IN THE FORM.
I agree to the above statement
Date
Signature
SUBMIT
PRINT
Safeguarding Teachers
138 Sydenham Rd, London SE26 5JZ
0208 778 9944 / [email protected]
8