CHURCH OF ENGLAND - DIOCESE OF SOUTHWARK Modern Foreign Languages -TEACHING STAFF APPLICATION SOUTHWARK DIOCESAN BOARD of EDUCATION

CONFIDENTIAL NAME OF SCHOOL

Closing date for completed form:8am, Monday, 3rd February 2014 Return form to: Mrs C!rist"s #c!ool, Ric!mond, #urrey $%10 &'% Ralp!

.lease state (!ere you sa( t!e ad/ertisement for t!is post:

to (!om all )ueries s!ould be addressed *ralp!+c!rists,ric!mond,sc!,u! APPLICANT"S PERSONAL DETAILS $0$12: F0R#$ 34M2: #5R34M2:

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# TEACHER STATUS

8o you !a/e <ualified $eac!er #tatus 4re t!ere any restrictions on your residence or employment in t!e 59= 0f ;es, please gi/e details $ SUPPORTING STATEMENT
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%it! reference to t!e ?o/ernors@ selection criteria, please gi/e details of your eAperience, s-ills, abilities and personal )ualities t!at you belie/e are rele/ant to your suitability for t!e post and indicate !o( you meet t!e person specification, 4lso pro/ide any additional information (!ic! you t!in- (ould be useful in t!is *ob, .lease (rite t!is on a separate s!eetBsC of paper,

% PRESENT OR MOST RECENT EMPLO&MENT

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' PRE(IOUS TEACHING EMPLO&MENT )s*ar* +i*, -os* re.en* / 01ease e201ain an3 ga0s in e-01o3-en*4 #c!ool, college or ot!er employer $ype D status of establis!ment 4ge range and roll BapproAC $itle of post Binclude special responsibilitiesC 8ates of employment

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5 EDUCATION AND ACADEMIC 6UALIFICATIONS #c!ool>college>uni/ersity #econdary Bpost 1&C From $o #ub*ects><ualifications>?rades>'onours, dates a(arded and a(arding body

'ig!er 2ducation

Furt!er postgraduate )ualifications Bincluding .?C2C

7 IN-SER(ICE TRAINING UNDERTAKEN DURING THE PAST $ &EARS RELE(ANT TO THIS APPLICATION

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Course title

.ro/ider

8ates D duration of course

4(ard Bif anyC

8 OTHER PAID WORK E9PERIENCE )01ease e201ain an3 ga0s in e-01o3-en*4 2mployer From $o 3ature of 7ccupation

: DETAILS OF OTHER ACTI(ITIES; SKILLS AND INTERESTS RELE(ANT TO THIS POST

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!< RELIGIOUS AFFILIATION

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8etails of your )ualifications and eAperience (!ic! you feel are especially rele/ant to teac!ing in a C!urc! of 2ngland sc!ool, not included in your supporting statement, %!ere appropriate, please include details of a C!ristian or ot!er fait! commitment and any centre of (ors!ip you regularly attend,

!! PROFESSIONAL REFERENCES - 01ease su0013 *,e na-es and addresses o= *+o 0ersons +i11ing *o 0ro>ide re=eren.es? One s,ou1d @e =ro- 3our .urren* Head*ea.,er? I= 3ou are no* .urren*13 +orAing +i*, .,i1dren; a re=eren.e =ro- *,e e-01o3er @3 +,o- 3ou +ere -os* re.en*13 e-01o3ed *o +orA +i*, .,i1dren +i11 @e reBuired? Re=eren.es +i11 no* @e a..e0*ed =ro- re1a*i>es or 0eo01e +ri*ing so1e13 in *,e .a0a.i*3 o= =riends? 34M2: 488R2##:

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.7#0$073 '218: .lease state t!e conteAt in (!ic! t!is person is -no(n to yourself:

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.7#0$073 '218: .lease state t!e conteAt in (!ic! t!is person is -no(n to yourself:

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!# DECLARATION C& APPLICANT 0 understand t!at appointment to t!is post is sub*ect to a satisfactory 2n!anced Criminal Records :ureau disclosure, 0 also understand t!at, under t!e terms of t!e Re!abilitation of 7ffenders 4ct 1FG4 B2Aceptions 7rder 1FGE, and subse)uent amendmentsC, 0 am re)uired to disclose any record 0 may !a/e of criminal con/ictions, cautions and bindHo/ers, including t!ose regarded as Ispent" and to attac! details of t!e same,J 'a/e you a record of criminal con/ictions, cautions or bindHo/ers= ;es Bdetails attac!edC 3o

J .lease note information about criminal con/ictions, cautions and bindHo/ers (ill remain confidential but (ill be made a/ailable to t!e panel for consideration if your application is ot!er(ise deemed (ort!y of s!ortHlisting, 0 declare t!at 0 am not on 1ist FF, or dis)ualified from (or-ing (it! c!ildren, or sub*ect to any sanctions imposed by a regulatory body Bi,e, t!e ?eneral $eac!ing CouncilC 0 understand t!at under t!e terms of t!e 0mmigration, 4sylum and 3ationality 4ct 200&s!ould 0 be s!ortHlisted for t!e post for (!ic! 0 am applying, 0 (ill pro/ide for t!e go/erning body, as employer, an original documentJ s!o(ing my entitlement to (or- in t!is country,
J4cceptable documents include your 3ational 0nsurance card, a birt! certificate issued in t!e 59 or 2ire, a .4E from your pre/ious employer, a /alid passport, or any rele/ant aut!orisation allo(ing you to (or- in t!is country,

0 appreciate t!at 0 must declare any family or close relations!ip (it! a member of t!e sc!ool@s ?o/erning :ody, an employee of t!e sc!ool or senior official of t!e local education aut!ority (!ic! !as responsibility for t!e sc!ool, 0 understand t!at failure to disclose suc! a relations!ip may result in my dis)ualification, 0 certify t!at all information gi/en by me on eac! section of t!is form and in supporting documents is correct to t!e best of my -no(ledge and belief, t!at all )uestions !a/e been fully and accurately ans(ered, and t!at 0 possess all )ualifications (!ic! 0 claim to !old and (ill produce e/idence of t!e same, 0 ac-no(ledge t!at 0 !a/e read, understand and (ill comply (it! t!e 3otes to 4pplicants (!ic! accompanied t!is application form, 0 understand t!at my name (ill be (it!dra(n from t!e list of candidates if, prior to appointment, 0 am found -no(ingly to !a/e omitted or concealed any rele/ant fact, and 0 ac-no(ledge t!at suc! disco/ery subse)uent to appointment is li-ely to lead to my dismissal (it!out notice and, (!ere appropriate, referral to t!e police, 0 !ereby consent to t!e processing of sensiti/e personal data, as defined by t!e 8ata .rotection 4ct 1FF8, in/ol/ed in t!e consideration of t!is application, #0?328: 84$2:

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ADDITIONAL INFORMATION )CONFIDENTIAL4 - T,is se.*ion o= *,e =or- seeAs addi*iona1 in=or-a*ion 0er*inen* *o 3our a001i.a*ion? I* +i11 @e re-o>ed @e=ore s,or*1is*ing and +i11 no* @e seen @3 an3 -e-@ers o= *,e se1e.*ion 0ane1? A..ess *o i* +i11 @e 1i-i*ed *o s*a== in>o1>ed in ad-inis*ering *,e a00oin*-en* 0ro.ess +,o need a..ess =or eBua1 o00or*uni*ies -oni*oring or *o *aAe ad-inis*ra*i>e a.*ion @ased u0on *,e in=or-a*ion 0ro>ided e?g? O..u0a*iona1 Hea1*, re=erra1 Posi*ion a001ied =or $itle: 8ate of birt!: 4re t!ere any reasonable ad*ustments you (ould li-e us to ma-e to enable you to participate fully and fairly in t!e recruitment process= ;es 0f ;es, please gi/e details: 3o First name: #urname:

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E6UAL OPPORTUNITIES MONITORING - +e +is, *o -oni*or .on*inuous13 )in *,e s*ri.*es* .on=iden.e4 *,e 0rogress o= our EBua1 O00or*uni*ies Po1i.3? P1ease ,e10 us @3 gi>ing *,e =u11es* 0ossi@1e ans+ers *o *,e Bues*ions @e1o+? Se2 M F Age 20H2F 30H3F 40H4F E0HEF &0H&E

0 consider myself to be disabled (it!in t!e meaning of t!e 8isability 8iscrimination 4ct 1FFE P1ease indi.a*e 3our .u1*ura1De*,ni. origins $!is information is included as part of t!e duty of t!e sc!ool to promote race e)uality and to ensure e)ual opportunities for all staff and is recommended by t!e Commission for Racial 2)uality B(((,cre,go/,u-C, White :ritis! 2nglis! #cottis! %els! 7t!er: please (rite in 0ris! 4ny ot!er %!ite bac-ground: please (rite in Black, Black British, Black English, Black Scottish or Black Welsh Caribbean 4frican 4ny ot!er :lac- bac-ground: please (rite in Asian, Asian British, Asian English, Asian Scottish or Asian 0ndian .a-istani :anglades!i 4ny ot!er 4sian bac-ground: please (rite in Mixed %!ite D :lac- Caribbean %!ite D :lac- 4frican %!ite D 4sian 4ny ot!er MiAed bac-ground: please (rite in Chinese, Chinese British, Chinese English, Chinese Scottish or Chinese Welsh or other ethnic group C!inese 4ny ot!er bac-ground: please (rite in Prefer not to state Put a cross here if you prefer not to state your ethnic group

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No*es *o a001i.an*s :efore signing t!is form please c!ec- t!at e/ery section !as been completed, $!e form s!ould be returned as instructed in t!e details of t!e post, 2nclose a stamped addressed en/elope if you (is! us to ac-no(ledge your application, ;ou are reminded t!at t!is is an application form for a post in a C!urc! of 2ngland>C!urc! in %ales 6oluntary 4ided sc!ool or a Foundation sc!ool in (!ic! t!e ?o/erning :ody is t!e employer, 0f you are appointed t!e Contract you (ill be as-ed to sign (ill include t!e follo(ing clause Bt!e second paragrap! is omitted in t!e case of a Foundation sc!ool or (!ere you are not re)uired to gi/e religious educationC: o 4s a teac!er in a C!urc! of 2ngland>C!urc! in %ales sc!ool you are re)uired to !a/e regard to t!e C!ristian c!aracter of t!e sc!ool and its Foundation and to underta-e not to do anyt!ing in any (ay contrary to t!e interests of t!e Foundation, ;ou are re)uired to gi/e and>or super/ise t!e gi/ing of religious education in accordance (it! t!e doctrines of t!e C!urc! of 2ngland>C!urc! in %ales and $rust 8eed of t!e #c!ool, ;ou are re)uired to ta-e part in and lead acts of religious (ors!ip,

$!e successful applicant (ill be re)uired to pro/ide an 2n!anced 8isclosure from t!e CR:,

Details of referees 7ne referee s!ould be your current or most recent employer, 0f you are not currently (or-ing (it! c!ildren but !a/e done so in t!e past, a reference (ill be re)uired from t!e employer by (!om you (ere most recently employed in (or- (it! c!ildren, $!e sc!ool (ill see- references on s!ortHlisted candidates, and may approac! pre/ious employers for information to /erify particular eAperience of )ualifications, before t!e inter/ie(, 0f you are currently (or-ing (it! c!ildren, on a paid or /oluntary basis, your current employer (ill be as-ed about disciplinary offences relating to c!ildren, including any penalty (!ic! is time eApired and (!et!er you !a/e been t!e sub*ect of any c!ild protection concerns, and if so, t!e outcome of t!e en)uiry or disciplinary procedure, 0f you are not currently (or-ing (it! c!ildren but !a/e done so in t!e past, t!e rele/ant pre/ious employer (ill be as-ed about t!ose issues, References from relati/es or friends (riting solely in t!e capacity of friends (ill not be accepted,

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