APPLICATION FOR EMPLOYMENT WITH PARKFIELD PRIMARY SCHOOL

Before completing, please ensure you have read the guidance notes in the application pack or
on our website. You may use additional sheets if you need to.

Please return this form to address given in the Advertisement or Application Pack
Application for the post of
Name of School or Academy
Job Reference Number
Closing Date
How did you hear about this job?
(Name of publication if advertised)

Part A: Personal Details (Block capitals please)

Family Name / Surname
Previous Name(s)
Forename(s)
Known Name:
(If different from Forename)
Preferred Title
(Eg. Mr, Mrs, Miss, Ms, Dr)
Current Address
(Please include Postcode)
National Insurance Number
Preferred Contact Telephone
Number
Alternative Telephone Number
(If available)
Email Address
Please note that correspondence
will be via email whenever
possible
Date of Birth (See note* below)
*Date of birth must be disclosed if the post involves working with children..

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Part B: Present (or most recent) Employer
Name and Address Are you currently employed by an
of Employer Agency? Yes No
If yes, please give the name of the
Agency
Job Title
Start Date Notice required or
date left
Salary If part-time, please
give hours per week
Please give details of your main tasks and responsibilities – and, if applicable, your reason for
leaving:

Please explain why you are applying for this post at this time:

Part C: Employment History (most recent first)

Please give as much relevant information as possible. For posts working with children, you must
give your full employment history from when you left school/higher education and explain any
gaps in your employment and include dates. Please include any time spent employed as a
volunteer.
Name & Address of Dates From/To Job Role Final Salary and
Employer (MM/YY) (for previous roles in Reason for Leaving
(for previous roles in schools please provide age
schools please provide range taught/ curriculum
type of school, size of responsibilities/ subjects)
school – NOR)

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Part D: Academic, Professional and Vocational Qualifications
Proof of qualifications will be required at interview
Exams Passed (Level) Grade and Name of Educational Establishment and/or
Qualifications & Memberships Date Professional or Awarding Body
(Most Recent First) Achieved*

* As posts working in schools or academies involve working with children/vulnerable adults, you must provide all dates

Teacher Status: (to be completed by teachers only)

Do you hold qualified teacher status? Yes No

If you have answered yes, please provide TRN number

Have you completed an induction year as a Early Career Teacher Yes No

(previously known as Newly Qualified Teacher?

Part E: Training/Continuing Professional Development

Please give details of training/development activities which you consider to be relevant to this
post.
Training Course and Organiser Time spent Outcome - Grade Achieved
or Development Activity (Where applicable)

Part F: Personal Statement

You may continue on a separate sheet if you need to.

Key Competencies, Knowledge and Skills: Referring to the person specification, provide
examples of how you have demonstrated the key competencies and the knowledge and skill
requirements for this role. You may use experience gained from within and/or outside the
workplace to provide these examples. (We recommend that you use the different headings on
the person specification as a starting point.)

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Personal Attributes: Please describe ways in which you have demonstrated the personal
attributes required for this post, as outlined in the person specification.

Part G: Supplementary Information

Personal Transport: For posts which involve travel away from normal place of work:
Are you willing and able to travel to meet Yes No
the requirements of the post?
Please provide details of any current motoring convictions, disqualifications or penalty points,
with dates and reasons and/or any difficulties you foresee concerning travel:

PART H: REFERENCES AND DECLARATIONS

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References: Please provide the names of two professional referees, both of whom can write
with authority about your performance, abilities and competence in a work, voluntary or
educational environment. The first reference must be your manager or a senior manager
representing your current or most recent employer. If this post has not involved working with
children or vulnerable adults but a previous post has, that previous employer must be given as
your second referee. This applies even if you have done other work in between. References will
not be accepted from colleagues, relations or people who know you solely as a friend. If you do
not wish your current employer to be contacted prior to interview please tick the box below,
unless you are applying for a post working with children as below. Please note that if you are
successful at interview and are conditionally offered and accept the post, we will commence
pre-employment checks which will include contacting ALL referees.

If you are applying for a Headteacher post. For applicants currently in a substantive
Headteacher post, your referees must be your current Chair of Governors and your Director of
Children Services at your Local Authority or equivalent employing body. If you are not a current
substantive Headteacher, your referees must be your current Headteacher or equivalent person
and your current or most recent Local Authority or equivalent employing body.

Applicants applying for a post in a Catholic or C of E Voluntary Aided School are encouraged to
also give the name of a clerical referee .
*For posts working with children all references will be
requested before interview.

Name of first Referee

Job Title of Referee
Name of organisation
Address (including Postcode)

Email address if available

Daytime telephone number
Relationship to you (e.g., supervisor,
tutor)
Dates of your employment From: / To: /
Name of second Referee
Job Title of Referee
Name of organisation
Address (including Postcode)

Email address if available

Daytime telephone number
Relationship to you

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Dates of your employment From: / To: /
Name of clerical Referee (if applicable)
Job Title of Referee
Name of organisation
Address (including Postcode)

Email address if available

Daytime telephone number
Relationship to you
Dates of your employment From: / To: /
Declaration of Interest: Every applicant applying for a position in Parkfield Primary School who
knows they are related to any to a member of staff, pupil or a governor must disclose the
relationship in their application form. An applicant who fails to disclose this information will be
disqualified for appointment to the position and if appointed, may be liable to dismissal.

If you do have a relationship with a governor or staff member, this does not necessarily prevent
them from acting as a referee for you.
Are you related to, or do you have any personal relationships with any Yes No
of the following at Parkfield Primary School?
 Governors/trustees
 Staff
 Pupils
Name:
Position: Relationship:
Declaration
 I confirm that I am entitled to live and work in the United Kingdom.
 I am willing for this data to be held and processed by [insert name of school or academy]
and to be verified with relevant third parties. This may include previous employers.
 The information on this form is accurate. I understand that providing false information is
an offence and may lead to my application being disallowed or, should I be appointed, to
my dismissal and, where appropriate, may be referred to the police.
If you complete the form electronically and submit online or via email, please type in your name
into the signature box to indicate that you have read and agree to the declaration.

Signed Date

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 Confidential

Equal Opportunities- Recruitment Monitoring

This form will be kept separate from your application form. It is not referred to during the
selection process.

[ school/ academy] values diversity and is committed to promoting equality of opportunity for our
employees and job applicants.

We monitor our recruitment and selection practices to fulfil our statutory duty relevant to equality
in employment and to ensure our practices are fair, equitable and consistent with the aim of
appointing the best person for the job. Recruitment monitoring enables us to take active steps to
promote better policy and organisational practice.

The information you supply on this questionnaire will be recorded confidentially on our HR
Systems and held for a maximum of 12 months. During this time, it will be used solely for the
purposes of monitoring the profile of our job applicants. Access to the data will be restricted to
nominated staff.

If you are appointed, the data will also be used for our HR/Payroll records purposes, which
includes another legal requirement, workforce monitoring. We aim to ensure all applicants and
employees, regardless of circumstances or status, receive equal access to opportunity and fair
treatment.

For these reasons it is important that you complete the recruitment monitoring questionnaire in
addition to the application form. Once completed, the questionnaire should be returned with your
application to the Recruitment Administrator, the address of which is detailed in the Recruitment
Information Pack.

Thank you for completing this information.

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 This information will be treated in the strictest confidence

EQUAL OPPORTUNITIES – RECRUITMENT MONITORING

Post Applied for Reference No:

Name: What is your date of birth?

Are you?
Please tick one of the appropriate boxes against each the questions below
Gender
1. Female 2. Male 3. Prefer not to say
Sexual Orientation
1. Bisexual 2. Gay /Lesbian 3. Heterosexual 4. Prefer not to
say
Transgender
1. Yes 2. No 3. Prefer not to say
How would you describe your ethnic origin?
a) White Z. English/Welsh/Scottish/North K. Gypsy or Irish Traveller
Irish/British
D. Irish Q. Any other White
Background

b) Mixed/Multiple H. White and Black Caribbean I. White and Black African

Ethnic
J. White and Asian S. Any other mixed
background

c) Asian or Asian E. Indian X. Pakistani G. Bangladeshi

British
P. Chinese Y. Any other Asian
background

d) Black/African T. Caribbean V. African R. Any other

/Caribbean/ Black black
British background
e) Other ethnic group A. Arab B. Any other group
f) Prefer not to say
Do you consider yourself to have a disability or impairment?
Under the Equalities Act 2010, a person with a disability is defined as having a physical or mental
impairment which has a substantial, long term effect on their ability to carry out normal day to day
activities.
Yes No Prefer not to say

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If yes, please indicate the nature of your disability.
Physical Impairment Mental Impairment Mobility Impairment

Visual Impairment Hearing Impairment Learning Disability

More than one Other Prefer not to say

Impairment
Which Religious Group do you belong to?
0 Buddhist 1 Christian 2 Hindu 3 Jewish 4 Muslim

5 Sikh 6 No 7 Any other 8 Prefer

Religion religion not to
say

Thank you for completing this information

Please return the questionnaire with your application form.