Equal Opportunities Form

Basic Information

Title* First Name* Middle Name(s) Last Name* Previous Name Mobile/Cell Phone Number Home Telephone Email Address* Address* Postcode* Country* National Insurance Number

I am qualified to work in the UK?*YesNo

Are you applying for this vacancy as a job sharer?*YesNo

Supporting Statement

Please upload your statement here. Use it to explain why you're right for this job. Include any experience, skills or other information which you think makes you suited to this particular role. Your application may not be considered if you leave this section blank or if you don't tailor it to this role. No file chosen

Employment History

Job Title* Employer* Location*

I currently work here*YesNo

Date from* Date to* Summary of main duties and responsibilities* Reason for leaving*

Do you have any gaps in your employment history? Schools may not consider your job application if you don't explain any gaps in your employment/education history.*NoYes

If yes, please explain the reasons for the gap and include the dates.

Teaching Information

Subjects Taught Ages you have taught DfE Number

I have Qualified Teacher Status

I have a National Professional Qualification for Headship (NPQH)

Teacher Training & Professional Development

Teacher Training Provider* Location* Training Type (eg PGCE)* Date From Date To

Professional Development

	Provider	Course	Duration

Membership of professional bodies (such as subject associations)

Education

Higher Education

	University/College	Subject	Qualification (eg BA)

	Result (eg 2:1)	Year from	Year to

Secondary/Further Education

	School/College Name	Year from	Year to

A-Levels or equivalent (ie IB, AP)

	Subject	Exam	Grade

GCSEs or equivalent

	Subject	Exam	Grade

Additional Skills

If you have any additional skills, hobbies or abilities that you think would be useful to share with potential employers, but that you would not mention in a personal statement, please add them here.

I hold a full current driving licence*YesNo

Referees

Current or most recent employer

I am happy for a potential employer to contact this referee prior to interview*YesNo

Title Name of referee Position Held Organisation How do you know the referee ? Addresss Postcode Email Address* Contact Number*

Second Referee

I am happy for a potential employer to contact this referee prior to interview*YesNo

Title* Name of referee* Position held* Organisation* How do you know the referee? Address* Postcode* Email Address* Contact Number* If you have worked with any employers you have listed above for less than 24 months, please add additional referee details. No file chosen If you're related to any current employees, pupils or governors, please state their name and the nature of your relationship.

Equal Opportunities Monitoring

This section is for monitoring purposes only. When you apply for a job, it'll be provided to schools as a seperate document to the rest of your application.

Nationality Cultural/Ethnic Background Date of Birth Gender Sexual Orientation Religion/Belief

The Equality Act 2010 defines a person as having a disability if she/he has a physical on mental impairment that has a 'substantial' and 'long-term' negative effect on his/her ability to do normal daily activities.

Do you consider yourself to be disabled according to the definition above?* If you're selected for an interview are there any special arrangements the employer should make for you?

Declarations

Do you have any convictions, cautions, reprimands or final warnings, whether in the United Kingdom or in another country? These should exclude those defined asprotected by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 as amended in 2013.*NoYes

If yes, please provide details

Are you included in any list of people barred from working with children by the Disclosure and Barring Service (DBS) or the NCTL {National College of Teaching and Leadership)?*NoYes

Have you ever been subject to any disciplinary action in a previous position or had any allegations made against you?*NoYes

If yes, please provide details

Are there any restrictions on your being resident or being employed in the UK?*NoYes

If yes, please provide details

Have you lived outside the UK for more than three months in the past five years?*NoYes

If yes, please provide details. Please specify which countries and the month and year those stays started and ended. If you're currently registered with the DBS Update Service, please provide your registration number Date your DBS certificate was originally issued

I certify to the best of my knowledge and belief the information given in this application is true and accurate. understand that if the information is false or misleading it will disqualify me from my appointment or after appointment could lead to a disciplinary action or dismissal. I acknowledge that where this form is submitted electronically and without a signature, electronic receipt of this form by the employer will be deemed equivalent to submission of a signed version and will constit ute confirmation of the declaration.*