Email address Tel No Job title Organisation May we contact this referee prior to interview? Yes / No (select as applicable) Second referee Full name Address Email address Tel No Job title Organisation May we contact this referee prior to interview? Yes / No (select as applicable) Warnings and Disciplinary Issues Have you ever been dismissed or have you ever resigned in the Yes / No face of a dismissal or warning? (select as applicable) Have you ever been the subject of any allegations in relation to the safety and welfare of children, young people and/or Yes / No vulnerable adults, either substantiated or unsubstantiated? If you have answered yes to the above question, you must supply details on a separate sheet of paper, place it in a - For the attention of the sealed envelope marked ‘Confidential and attach it to your application form. Recruitment Support Team’ I have attached details requested Yes / No Please list any disciplinary offences or warnings you have received at any time, or state if not applicable. Reason for warning Date Name/address of employer Prohibition Orders on Teaching Assistants Have you ever been employed as a teacher, member of the school leadership team, or an instructor in a maintained school, Yes / No academy, independent school or in the FE or HE sector? Have you ever been prohibited from teaching? Yes / No If YES, please give details below including the date of prohibition, and the reason. Rehabilitation of Offenders Act 1974 You are required to declare any criminal convictions (including bind over and cautions) which are not in accordance with the Rehabilitation of Offenders Act 1974. Some “spent”
Email address Tel No Job title Organisation May we contact this referee prior to interview? (select as applicable) Yes / No Second referee Full name Address Email address Tel No Job title Organisation May we contact this referee prior to interview? (select as applicable) Yes / No Warnings and Disciplinary Issues Have you ever been dismissed or have you ever resigned in the face of a dismissal or warning? (select as applicable) Yes / No Have you ever been the subject of any allegations in relation to the safety and welfare of children, young people and/or vulnerable adults, either substantiated or unsubstantiated? Yes / No If you have answered yes to the above question, you must supply details on a separate sheet of paper, place it in a sealed envelope marked ‘Confidential - For the attention of the Recruitment Support Team’ and attach it to your application form. I have attached details requested Yes / No Please list any disciplinary offences or warnings you have received at any time, or state if not applicable. Reason for warning Date Name/address of employer Prohibition Orders on Teaching Assistants Have you ever been employed as a teacher, member of the school leadership team, or an instructor in a maintained school, academy, independent school or in the FE or HE sector? Yes / No Have you ever been prohibited from teaching? Yes / No If YES, please give details below including the date of prohibition, and the reason. Rehabilitation of Offenders Act 1974 You are required to declare any criminal convictions (including bind over and cautions) which are not “spent” in accordance with the Rehabilitation of Offenders Act 1974. Some
Support%20Staff%20application%20form%20Feb%2017.docx