Assumption Grammar School
Ballynahinch
FOR OFFICE USE ONLY
DATE:
TIME:
Please complete in full in black ink or font
All questions must be answered
No additional information pages or CV will be accepted
APPLICATION FOR POST OF PRINCIPAL
1
PERSONAL
1.1
FULL NAME:
1.2
FULL ADDRESS:
___________________________________________________________
_______________________________________________________
_________________________________________________________________________
_______________________________________
TELEPHONE NO: ______________
1.3
EMAIL ADDRESS: _________________________ MOBILE NO: _________________
1.4
TEACHER’S REF NO:
2
QUALIFICATIONS
__________
UNIVERSITY
a)
NAME: ___________________________
YEAR OF ENTRY: ___________
DEGREE:
STATE IF PASS OR HONS: _________
__________________
IF HONS, STATE CLASS: _________________
YEAR OF GRADUATION:
_________
DEGREE SUBJECTS: _____________________________________________________
b)
OTHER DEGREES:
__________________
STATE IF PASS OR HONS: _________
UNIVERSITY: ________________________
YEAR OF ENTRY: _______________
YEAR OF GRADUATION:
___________
DEGREE SUBJECTS: _________________________________________________________
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c)
DIPLOMA(S): ______________________________________________________________
UNIVERSITY / COLLEGE: ____________________________
YEAR: ____________
3i) OTHER QUALIFICATIONS OF AT LEAST 1 YEAR DURATION
3ii) EMPLOYMENT RELATED TRAINING AND DEVELOPMENT
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4
EMPLOYMENT HISTORY BEGINNING WITH THE MOST RECENT
FROM
5
TO
POSITION
SCHOOL OR OTHER EMPLOYER
SENIOR LEADERSHIP EXPERIENCE:
3
NO. OF PUPILS
6
OUTLINE WHY THE BOARD OF GOVERNORS SHOULD APPOINT YOU
TO THIS POST AS OUTLINED IN THE ATTACHED DOCUMENTATION.
(In Not More Than 400 Words)
4
7
REFERENCES
Please give names, addresses and telephone numbers of two persons willing to give references, one of
whom should be able to comment on your current professional work as a teacher. Prior consent is
required.
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1 Professional
2 Character
_____________________________
___________________________
_____________________________
___________________________
_____________________________
___________________________
_____________________________
___________________________
_____________________________
___________________________
Tel No: ______________________
Tel No: ____________________
ATTENDANCE RECORD
Please indicate the dates of your sickness absences since 1 January 2009 and the reason for the absence.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
The School reserves the right to verify the above information with your current or previous employer.
Appointment will be subject to satisfactory references and medical certification.
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CRIMINAL OFFENCE(S)
Have you been convicted of any criminal offence?
Yes / No
Please give details (include nature of offence and sentence).
_________________________________________________________________________
_________________________________________________________________________
NOTE: This post is (or may be) exempt from the provisions of the Rehabilitation of Offenders (Exceptions)
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.
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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:
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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 believe that I have the necessary physical and psychological stamina to carry out the responsibilities of
this post.

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: ______________________________________________
__________________________________________________________________________________
Usual Signature of Applicant: __________________________
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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 Note: Late application forms will not be accepted.
Faxed or Emailed application forms will not be accepted.
THIS FORM SHOULD BE RETURNED TO:
The Chairperson of the Board of Governors
Rev Canon G McCrory,
Parochial House,
24 Church Street,
BALLYNAHINCH,
BT24 8AF
NOT LATER THAN 12.00 NOON ON FRIDAY 30 MAY 2014
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