Submit an Application

1. Personal Details

Title (Mr, Mrs, Miss, Ms)
First Name(s)
Surname
Any Former Forenames
Address (Please provide your last 5 years of addresses)
Postcode From: To:
Previous Address - 1
Postcode From: To:
Previous Address - 2
Postcode From: To:
Home Telephone Number
Mobile Number
Email Address
National Insurance


2. Education and Qualifications

Please give details of your education and any qualifications obtained with most recent first. This should include any qualifications which you are currently studying for. You will be required to produce original documents, a certified copy, or letter of confirmation from the awarding authority for all your qualifications and accreditations at your registration interview.

Qualifications obtained overseas must be supported by NARIC accreditation.

Institute / University / College / Secondary School Qualifications and Grades Achieved Date Awarded


3. Current or Most Recent Employment

Name of Local Authority or Employer
Name and address of School or Establishment
Postcode
Telephone Number
Position Held
Employment Type(permanent / temporary / supply)
From: (month / year)
To: (month / year)
Please give a brief description of the main duties of this post


4. Previous Employment

Name of School or Employer FT / PT / Supply Position Held From Month / Year To Month / Year Reason for Leaving


5. Professional Memberships

Membership of Professional Association and Level Dates
Membership Number

All qualified and un-qualified teachers must be registered with the Teaching Agency (TA) or formally known as the General Teaching Council.

Are you registered with the TEACHING AGENCY? Yes No

If yes, date of registration:

Registered in: England Scotland Ireland

Teacher Reference Number:

Do you have Qualified Teacher Status (QTS)? Yes No

Date QTS attained

If you qualified as a teacher after 7th May 1999, have you successfully completed your NQT Induction? Yes No


6. In-Service Courses and Additional Achievements

(Swimming awards, music certificates, coaching awards, etc.)

Title of Training Programme / Course Date Awarding Body


7. Right to Work in the UK

Are you eligible to work in the UK?  Yes  No
Do you need a work permit to work in the UK?  Yes  No
If yes, please give the date of your current work permit expires

You will be required to present original and valid evidence of eligibility to work in the UK at your interview.


8. Criminal Convictions

This appointment is exempt from the Rehabilitation of Offenders Act 1974 and subject to an enhanced DBS check in accordance with the Disclosure and Barring Service and the Police Act 1997. You must declare all convictions, cautions or bind-overs you may have, even if they would otherwise be regarded as “Spent” under this Act. In the event of Cumbria Teaching Agency placing you to work, failure to disclose a conviction, caution or bind-over could result in dismissal or disciplinary action by the Local Authority and possible referral to the Police.

Have you ever been convicted of a criminal offence or been given a caution; reprimand; warning or bind-over? Yes No

If yes, please provide the details below:

Signed Date


9. References

Candidates must give names and addresses of at least two work references and one personal reference. (Work referees must not be relatives, friends or people who you live with)

Please provide Work References of work references for the last 3 years of employment as well as a Personal Reference who will have known you for at least 5 years.

Any voluntary which you have conducted in an educational establishment must be referenced if within the last 3 years.

Name of Referee (1)
Position
School / Company
Address
Dates of Employment (mm / yy) From: To:
Telephone Number
E-mail
Name of Referee (2)
Position
School / Company
Address
Dates of Employment (mm / yy) From: To:
Telephone Number
E-mail
Name of Referee (3)
Position
School / Company
Address
Dates of Employment (mm / yy) From: To:
Telephone Number
E-mail
Personal Referee
Position
School / Company
Address
Dates of Employment (mm / yy) From: To:
Telephone Number
E-mail

May we contact your references now? Yes No

If no, which references are we not to contact? Referee 1 Referee 2 Referee 3 Personal Referee


10. Declaration

I declare that the information I have provided is correct and any changes to my circumstances, I will inform Cumbria Teaching Agency at the earliest opportunity.

I understand that full registration with Cumbria Teaching Agency is subject to successful references and an Enhanced DBS Disclosure.

I also understand that the information provided on this application form will be used to form basis of a personnel file and a computerized personnel record.

Print Name
Signature
Date

 Please Tick This Box To Indicate You Are Satisfied With the Information You Have Provided (required)