The Corby Academy

+ c/o Brooke Weston, Coomb Road, Great Oakley, Corby, Northants, NN18 8LA
REF:
(: 01536 746652 2: 01536 742804 8:www.corbybusinessacademy.org *:enquiries@corbybusinessacademy.org

Application for post of:

i. Present appointment
A) If teaching: name of LEA:
Name and address of school:

Postcode: Tel:
Number on roll (approx): Boys/Girls/Mixed (delete as appropriate)
Age range: Date appointed:
Post title:
Subject/Age groups taught: Salary:
When could you commence duties?

B) If other than teaching: nature of post:

Name and address of employer:

Date appointed: Salary:

Length of notice: When could you commence duties?

ii. Past employment

Full time or part time, including all employment since the age of 18 and any unremunerated activity e.g. unpaid voluntary work.
Please providde the information in chronological order.

Employer Name & type of school Roll No. Post held FT/PT Dates from Dates to
or nature of employment (if school) (mm/yy) (mm/yy)

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 The Corby Academy
+ c/o Brooke Weston, Coomb Road, Great Oakley, Corby, Northants, NN18 8LA
REF:
(: 01536 746652 2: 01536 742804 8:www.corbybusinessacademy.org *:enquiries@corbybusinessacademy.org

iii. Education: secondary/further

Names of institutions attended FT/PT Dates from (mm/yy) Dates to (mm/yy)

Examinations passed Date Subject and grades

GCE A-level or equivalent:

Other (please specify):

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 The Corby Academy
+ c/o Brooke Weston, Coomb Road, Great Oakley, Corby, Northants, NN18 8LA
REF:
(: 01536 746652 2: 01536 742804 8:www.corbybusinessacademy.org *:enquiries@corbybusinessacademy.org

iv. Education: higher

University, college, polytechnic – including professional qualifications and in-service courses leading to recognised
qualifications.

University/College and/or
Date from Date to Exam date Qualification Subjects *Age
University education FT/PT
(mm/yy) (mm/yy) (mm/yy) obtained passed/grade groups
department

* Please state which age groups for which your are trained.

v. Professional courses attended

Courses attended in the past three years (other than those mentioned above).

Subject Organising body Approximate date Duration

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 The Corby Academy
+ c/o Brooke Weston, Coomb Road, Great Oakley, Corby, Northants, NN18 8LA
REF:
(: 01536 746652 2: 01536 742804 8:www.corbybusinessacademy.org *:enquiries@corbybusinessacademy.org

Personal information
This part of the form will be used following appointment and for equal opportunity monitoring. It will be detached on receipt
and the information given below will not be available to those involved in short listing, interviewing and appointing staff.

i. Personal details
Post applied for: Full name and title:
Home address:

Tel: Mobile:
Email address:

ii. Employment information

DfES number (if applicable):
National Insurance number: Male: Female:

iii. Additional information

Have you ever been subject to an investigation by the GTC? Yes | No
If so please state the outcome including any orders or conditions of registration:

Have you been CRB checked in your present post? Yes | No

Are you subject to any legal restrictions in respect of your employment in the UK? Yes | No
Do you require a work permit? Yes | No
Are you, to your knowledge, related to any Member of the Governing Body? Yes | No
If so give details:

Have you at any time been debarred from teaching by the DfES? Yes | No
Do you hold a current Driving Licence? Yes | No

iv. Notice to applicants

You will appreciate that The Academy must be particularly careful to inquire into the character and background of applicants
for appointment to posts involving contact with children under the age of 18. It is therefore essential that, in making your
application, you disclose whether you have ever been convicted of a criminal offence or cautioned and, if so, for what
offence(s). Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section
4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders 1974 (exceptions) Order 1975 and
the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendments) Order 1986, the Police Act 1997 as amended by Part V
of the Protection of Children Act 1999. The fact that conviction/caution(s) have been reported against you will not necessarily
debar you for consideration for this appointment.
You must, therefore, answer the question below: “have you ever been convicted of a criminal offence or cautioned?” (Please
answer “yes” or “no”). If the answer is “yes”, you must give details which may, if you wish, be enclosed in a separate, sealed
envelope marked ‘confidential’ and attached to the application. Any information given will be completely confidential and will
be considered only in relation to an application for positions to which the order applies. The object of this Notice is not, in any
way, to reflect upon applicants’ integrity but it is necessary to protect the public and The Academy.
In accordance with the recommendations of the Home Office, all successful candidates for posts where there is to be contact
with children, will be the subject of a request to the Criminal Records Bureau which provide details of a person’s criminal
records including convictions, cautions, reprimands and warnings held on the Police National Computer (PNC). Acceptance of
an offer of appointment will be deemed to be acceptance that such an investigation may take place. Applicants are informed
that providing false information is a disciplinary matter and may result in summary dismissal. A copy of this notice will be sent
to your referees.
Have you ever been convicted of a criminal offence or cautioned? Yes | No

Page 4 of 5
 The Corby Academy
+ c/o Brooke Weston, Coomb Road, Great Oakley, Corby, Northants, NN18 8LA
REF:
(: 01536 746652 2: 01536 742804 8:www.corbybusinessacademy.org *:enquiries@corbybusinessacademy.org

v. References
(Give here details of two persons to whom reference may be made).

1. Reference
Name: Job title:
Address:

Tel: Position:

2. Reference
Name: Job title:
Address:

Tel: Position:

vi. Ethnicity
Please tick the box that best describes your ethnicity.
White - British: White other:
Mixed - White & Carribean: Mixed - White & black African:
Mixed - Any other mixed background: Asian or Asian British - Indian:
Asian or Asian British: Asian or Asian British - Bangladeshi:
Asian or Asian British - other: Black or Black British - Carribean:
Black or Black British - African: Chinese:
Prefer not to say:

vii. Notes
a) When completed, this form should be returned in accordance with the instruction in the advertisement
for the post.
b) Any personal information on the application form may be held on computer files and in accordance with
the Data Protection Act 1998, such information will only be used in conjunction with Data Protection
Registration.
c) Candidates must declare whether they are subject to any legal restrictions in respect of their
employment in the UK and/or require a work permit.
d) On the grounds of economy, it is not normally practicable to acknowledge receipt of application forms.
e) Canvassing, directly or indirectly a Governor will disqualify the application.
f) Candidates recommended for appointment will be required to complete a medical form and may be
required to undergo a medical examination.

viii. Letter of application

Please provide a letter of application in accordance with the job details.

ix. Declaration
I certify that, to the best of my knowledge and belief, all particulars included in my application are correct.

Signature of Candidate:

Date:
An Equal Opportunities Employer

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