1. TISBURY SCHOOL
APPLICATION SUMMARY AND DECLARATION FORM
1. Position: Please highlight the position you are applying for:
1) Maternity Leave Scale A –2015
2) Fixed Term 1 Year Scale A “Team Teaching” - Junior School
2. Personal Details:
Name: _____________________________________________________________________
Address: _____________________________________________________________________
_____________________________________________________________________
Contact Details: Cell-phone: _________________________________ Home Phone: _____________________
Email: ______________________________________________________________________
3. Teacher Registration: Type: Full / Provisional / Subject to Confirmation
Date of Registration: ________________________ Registration Number: ______________________
4. Conviction Against the Law:
Have you ever been convicted of any offence against the law (apart from minor traffic convictions)? Yes / No
If “YES” enclose a certified copy of the entry in the Criminal Record Book relating to the conviction(s) obtained from the Registrar of the Court concerned. The copy should be accompanied by any comments regarding the offence, which you wish to make, giving full details.
5. Referees:
Please provide details of two people who can be contact to provide references on your professional ability.
Name and Position:
Address:
Contact Details: Phone/Email
Relationship to Applicant:
1)
2)
6. Confirmation:
I agree to the Tisbury School Board of Trustees, or its agents, approaching my referees for a statement of my abilities in relation to this application. I further agree to the Tisbury School Board of Trustees approaching my current (or previous) employers, or colleagues, or any other person, who may assist in establishing my suitability for the position at the school.
I certify that the information given in this application is, to the best of my knowledge, correct. I understand that this information may be verified.
Applicants Signature: ___________________________ Date:________________________
(If sending electronically – please type name – a signed copy may be requested for file purposes).