Assumption Grammar School
24 Belfast Road, Ballynahinch, Co Down, BT24 8EA
Telephone: 028 97 562250
E mail: admin@assumption.ballynahinch.ni.sch.uk
APPLICATION FORM
(No additional information pages or CV will be accepted)
(Should be completed in full in black ink or may be typed)
POST APPLIED FOR
Also able to teach:
1
HEAD OF ART
_________________________________
Level: ________________________
_________________________________
Level: ________________________
PERSONAL INFORMATION
Surname
_______________________________
Dr/Mr/Mrs/Miss/Ms _____________
Forename(s) _______________________________
Present Address
Telephone No __________________
_______________________________________________________________
______________________________________________________________________________
National Insurance No: _____________________________
Email: __________________________________
Teacher’s Ref No __________________________
Mobile No: ________________________
GTCNI Registration No _____________
The successful candidate, if not already registered with the GTCNI, will be required to register and to provide proof
of registration to the Principal before taking up the appointment.
2
EDUCATIONAL ACHIEVEMENTS
Third Level Education
Dates
From To
Name and address of
University/College
Type of degree, diploma
or certificate
Main subjects studied
Results achieved
Class and division
Additional Qualifications
Please provide details including dates
Employment Related Training and Development
Dates
From
To
Training/Development Activity
3
EMPLOYMENT HISTORY
Please give details of the last three posts held beginning with your current or most recent
position.
Date of
Date of
Employer
Position
Salary
commencement termination
points
4
DUTIES OF PRESENT POST
5
OTHER EMPLOYMENT EXPERIENCE RELEVANT TO THIS APPLICATION
6
IN NO MORE THAN 150 WORDS, USING FONT ‘TIMES NEW ROMAN’, SIZE 11,
PROVIDE EVIDENCE OF HOW YOU FULFIL THE ESSENTIAL CRITERIA OF THIS
POST.
7
IN NO MORE THAN 100 WORDS, USING FONT ‘TIMES NEW ROMAN’, SIZE 11,
PROVIDE EVIDENCE OF HOW YOU FULFIL THE DESIRABLE CRITERIA OF THIS
POST.
8
IN NO MORE THAN 200 WORDS, USING FONT ‘TIMES NEW ROMAN’, SIZE 11,
PROVIDE EVIDENCE OF HOW YOU POSSESS THE SKILLS AND PERSONAL
QUALITIES REQUIRED FOR THIS POST.
9
REFERENCES
Please give the names, addresses and telephone numbers of two referees - one of these should be the
Principal of your current institution or the most senior manager in your current employment. Prior
consent must be obtained from referees. References should not be submitted with the application form.
Name
___________________________ Name
___________________________
Position
___________________________ Position
___________________________
Address
___________________________ Address
___________________________
(inc postcode)
___________________________ (inc postcode)
___________________________
___________________________
___________________________
Telephone No ___________________________ Telephone No ___________________________
10
CRIMINAL OFFENCE(S)
Have you been convicted of any criminal offence, cautioned or bound over, or is a charge pending?
Yes / No _________
If yes, please give details including nature of the offence and penalty (if any).
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
NOTE:
This post is (or may be) exempt from the provisions of the Rehabilitation of Offenders (Exceptions Amendment)
Order (NI) 1979. You are therefore not entitled to withhold information about convictions which for other purposes
are regarded as “spent” convictions. Any failure to disclose such convictions could lead to disqualification or dismissal.
Any information given will be used only in connection with posts to which the Order applies.
11 DISABLED PERSONS
Assumption Grammar School welcomes applications from people with disabilities. The Disability
Discrimination Act (NI) 1995 defines a disability as a physical or mental impairment which has a
substantial and long term effect on a person’s ability to carry out normal day-to-day activities.
Having read this definition, do you consider yourself to have a disability?
Yes / No _________
If yes, please outline below briefly the nature of your disability:
Are you registered under The Disabled Persons (Employment) Acts (NI) 1945 and 1960?
Yes / No _________
If yes, give Registration Number: ______________________
Do you require any arrangements to be made for you to attend an interview?
Yes / No _________
If yes, please outline below the nature of what these arrangements would be:
Please describe any reasonable adjustments which you feel would need to be made to enable you to
carry out the duties of the post:
12 DECLARATION
The Trustees and management wish to declare that an application is accepted on the understanding that
the candidate has read and subscribes to the mission and educational philosophy contained in the
school prospectus and accompanying documents enclosed with this application form.

I have read the documents “Fully Alive: Education in Assumption Schools” and the Aims of the
School, and subscribe to the religious and educational philosophy expressed therein.

I understand that the information on this form is required by the Board of Governors for the purpose of
processing my application. The information is covered by the provisions of the Data Protection Act
1998.

I understand that my signature on the form is deemed to be an authorisation by me to allow the Board
of Governors to process and retain the information for the purpose(s) stated. I have not canvassed, and
have not asked anyone to canvas on my behalf, any member of the Board of Governors in respect of
this post.

Relationship to a member of the Board of Governors
If you are aware that you are related to a member of the Board of Governors, please give the name(s)
of the relative(s) and the relationship to you: ______________________________________________
__________________________________________________________________________________
Signature of Applicant:
__________________________
Date: ______________
An applicant found to have given false information, or to have suppressed any material fact will be
liable to disqualification, or if appointed, to dismissal.
We are an equal opportunity employer.
Please return completed form to the Principal no later than 12 Noon on Tuesday 20 May 2014.
Please Note: Late application forms will not be accepted.
Faxed or Emailed application forms will not be accepted.