TEACHING STAFF

Thank you for your interest in applying for employment with The Hermitage Academy.

This form should only be used to make applications for advertised support staff positions.

If you wish to complete an application online please visit www.thehermitage-lc.net and follow the links under ‘About Us’ and ‘job vacancies’.

How to submit your Job Application form.

Please complete the following pages, using black ink or type, ensuring you complete all relevant parts.

Once you have completed your application form please ensure you have detailed which post it is you are applying for and ensure it is sent to:

Miss F Smith
Principal
The Hermitage Academy
Waldridge Park
Chester-le-Street
Co Durham
DH2 3AD

Please note if application forms are received late or sent to the incorrect address they are at risk of being excluded from the recruitment process.

Problems filling in this form or requests for other formats

If you have any queries or problems filling in this form and it isn’t in the guidance notes document or you need this form in another format, then please telephone the school on 0191 3887161 or email us at learning@thehermitageacademy.net

 Surname:	Title:	
Previous Surname(s):	Date Of Birth:	
Forename:	National Insurance Number:	
Address:	Telephone (home):	
	Telephone (mobile):	
Postcode:	Telephone (work) if convenient:	
Email Address:	
Post Applied For:	

Disability:
Do you consider yourself to be a person with a disability? This may include a physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities. Long-term means that it has lasted, or is likely to last, for over a year. Applicants with disabilities will be invited for interview if they meet the essential criteria on the person specification.	

Yes:	

No:	

Prefer not to say:	
If you have answered yes please detail below any specific requirements to assist you with an interview and we will try to make the necessary arrangements.	

IMPORTANT INFORMATION	

Criminal Convictions:
If after reading the guidance notes you have any spent or unspent convictions to declare please either declare them here, or if you prefer, send details by post marked 'For the attention of the Lead Officer, in strict confidence - only to be opened by the addressee’ stating the post title and post reference number.	
Details:

Data Protection Statement	
The Council is committed to confidentiality and complies with the Data Protection Act 1998. All information will be handled and stored sensitively and used only for its intended purpose.	

I have read the guidance notes including the information regarding Criminal Convictions and I declare that the information I have given is true in all respects. I understand that false information may render me liable for dismissal if I am appointed. I agree to the above statement and will sign and date a copy of this application as a true record if I am invited for an interview:	
Signature:	Date:	

A	Education	

Secondary Education:	
N.B. appointment will only be confirmed subject to receipt of official certificates in support of below.
(Please use continuation sheets if required)	
School Attended	Qualifications	Subject	Date	Grade	

					

Higher Education:	
	Institution	From	To	Degree, Diploma
Certificate	Date Awarded	Subject, Class
Division	
Degree							
Higher/ Advanced Degree / Diploma /
Certificate							
NPQH:	

Yes 	Date Obtained:	

No 	
In-Service Training:	
Name of Establishment	From	To	Course Taken	
				
Subsidiary subjects offered: e.g. Games, Music:
	
Particulars of residence abroad (for modern language posts):

B	Employment Details	

(1) Present Appointment (please state):
Please state whether present appointment is permanent or temporary	
Full or Part Time	Salary Grade
Indicate any allowances	Name of Establishment	Number on roll	Age Range	L.A.	Date of Appointment	

(1) Previous Appointments (please list most recent first):
Please state whether present appointment is permanent or temporary	
Post	Full or
Part Time	Salary Grade
Indicate any allowances	Name of Establishment	Number on roll	Age Range	L.A.	Date of Appointment	
							From	To	

B	Employment Details	

Do you have any additional employment which you intend to continue if appointed to this post?	

Yes	

No	
If yes, please detail the nature of the work and the hours:	
Period of notice required or termination date:	

C	Full Employment History	

Name & Address of Employer	Appointment held / Grade and or Salary (where applicable)	Dates (dd/mm/yyyy)	Reason for leaving	
		From	To		

					

D	Additional Information	

Subject(s) Secondary School only:	
Department of Education Ref. No:	
General Teaching Council No:	
To which Superannuation Act (if any) are you now subject? e.g. Local Govt, Teachers etc:	
To be completed in case of application only	
In which area(s) of the County do you wish to teach?	
Do you want full time, part time, permanent or temporary work?	
Have you already given notice to your present employer?	Yes	No	
If Yes when will you be able to commence?	
If No how much notice are you required to give?	

D	Additional Information	

Do you have any additional information that might be helpful to the Governors/Appointment Panel (continue on separate sheet if necessary)
	
E	Referees	

Give name, job title, relationship to referee and address of TWO people, who must know you well to whom a reference may be made. Referee 1 should be your present (or most recent) employer, or if you are a recent school leaver, should be the Head Teacher of your last school. Next of kin or immediate relatives should not be named as referees. Please note that for positions in contact with children and vulnerable adults the Council has the right to seek references from any or all previous employers and line managers prior to interview.	
Referee 1 Name:	Referee 2 Name:	
Job title:	Job title:	
Relationship to Referee:	Relationship to Referee:	
Address:
	Address:
	
Post Code:	Post Code:	
Telephone No:	Telephone No:	
Email:	Email:	
N.B. Appointment will only be confirmed subject to satisfactory references.