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 TEACHER OF RELIGION TO A2 LEVEL AND ENGLISH TO KS3
Also able to teach:
_________________________________
_________________________________
Level: ________________________
Level: ________________________
1 PERSONAL INFORMATION
Surname _______________________________ Dr/Mr/Mrs/Miss/Ms _____________
Forename(s) _______________________________ Telephone No __________________
Present Address _______________________________________________________________
______________________________________________________________________________
National Insurance No: _____________________________
Email: __________________________________ Mobile No: ________________________
Teacher’s Ref 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 commencement
Date of termination
Employer Position Salary points

4 DUTIES OF PRESENT POST
5 OTHER EMPLOYMENT EXPERIENCE RELEVANT TO THIS APPLICATION

6 IN NO MORE THAN 100 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 40 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 300 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
Address
___________________________
___________________________
Position
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.
School, and subscribe to the religious and educational philosophy expressed therein.

I have read the documents “Fully Alive: Education in Assumption Schools” and the Aims of the

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 application forms will not be accepted.
Emailed application forms will not be accepted.