Confidential Application Form

NLCS (Singapore)

Physical Education Teacher

Position applied for:

Personal details

Title Mr.
Forename(s) Jerwin
Surname Samson
Former name(s)
Contact number 09669603099
Email address Samson.jerwin28@gmail.com
Brgy uno Canuyao City Laguna Philippines
Current residential address

Are you Singaporean? No

Are you currently working in No
Singapore? If yes, what is your
current status?
Teacher reference number N/A
(if applicable)
Skype ID Jerwin Samson
Are you related to or do you maintain a close relationship with an existing student, employee,
volunteer, Governor or Trustee of North London Collegiate School (UK), NLCS Jeju, NLCS Dubai
or NLCS (Singapore)? Yes / No
If so, please provide details.
Have you previously applied for a role at an NLCS school? Yes / No
If so, please provide details. No
☐ Jobs Bank
☐ Jobstreet 
☐ NLCS website
Where did you hear about this
☐ Seek
job? (Please choose one)
∕☐ TES
☐ LinkedIn
☐ Other (Please specify) _______________
 Current or most recent employment

Our Lady Of Fatima University

Current/most recent employer
Current/most recent employer’s Sta Rosa City Laguna Philippines
address, including city and
country
Current/most recent job title
Physical Education Teacher
Date started Nov 11 2019
Date ended April 11 2020
Brief description of to provide maximum physical activity time within the class
responsibilities period, teach skills and activities that transfer into physical
activity outside of physical education class, motivate children to
be physically active, and take the role of physical activity
director for the schoo
Reason for seeking other Im looking for better career prospects, professional growth and
employment work opportunities.
Do you/did you receive any None
employee benefits? If so,
please provide details of these
Current salary/salary on leaving PHP 7,000
Please state when you would be May 2020
available to take up
employment, if offered
Previous employment
Please start with the most recent and please add extra rows if necessary.
Dates Name and address of Position held and/or Reason for
From To employer duties leaving
July August AITSA Faculty member End of Contract
Nov April OLFU Faculty Member End of Contract

Gaps in your employment

Please provide details of any gaps in your employment history, e.g. a sabbatical year or parental
leave.
Dates
Reason for gap Address/location during gap
From To

Education Qualifications
Please start with the most recent and please add extra rows if necessary.
Name of school/ Dates of attendance Examinations
college/ Awarding
From To Name of course Result Date
university body
Undergraduate and Postgraduate
Laguna state 2015 20219 Bachelor of pass June
polytechnic Secondary Education 2019
University
 School and Further Education

Professional Qualifications

Please start with the most recent and please add extra rows if necessary.

Dates of attendance Examinations

Name of college/
Awarding
university From To Subject Result Date
body

Professional development

Please provide details of any vocational qualifications or skills that you possess, or training that
you have received, which you consider to be relevant to the role for which you have applied.

 Oriented in Microsoft Office application Such as:

•Microsoft Office Word
•Microsoft Office Excel
•Microsoft Office Powerpoint
 Have knowledge in Playing Rondalla Instruments
 Have knowledge in Coaching and Officiating Sports Events
 Communication Skills
 Choreographer- Cheerdance, Streetdancing, Contemporary, Dancesport, etc.
 Leadership Skills
• Instructor/Facilitator Red Cross Youth Laguna

Interests/Extra-curricular activities

Please provide details of any interests/extra-curricular activities in which you have been involved.

NSTP Leadership Development Training

(Resource Speaker)
Sari Gamit Covered Court, BPSU-Main Campus,
City of Balanga, Bataan, Philippines
April 5-6 2019

NSTP Leadership Development Training

(Resource Speaker)
Sari Gamit Covered Court, BPSU-Main Campus,
City of Balanga, Bataan, Philippines
March 29-30 2019

DRRM and Red Cross Youth Leadership Development Program

(Resource Speaker)
Bubukal Elementary School Sta, Cruz Laguna
January 24-25 2019

2018 STRASUC Culture and the Arts Festival

Folk Dance Category
Laguna State Polytechnic University SPCC
San Pablo City, Laguna
October 3-5 2018

Seminar Workshop “Our Show-The Recital”

(Dance Choreographer)
Sunstar Mall Sta Cruz, Laguna
June 2, 2018

1st PRC Batangas Chapter Red Cross Youth Camp

(Resource Speaker)
Provincial Sports complex, Bolbok Batangas City
December 9 2017

20th National Youth Congress “ Red Cross Youth: a century as agents

of change, Motivated by Passion Reshaping the nation”
PRC Multi Purpose and logistic Hall
Mandaluyong City, Philippines
October 29, 2017

2017 STRASUC Culture and the Arts Festival

Folkdance Category Bronze Medallist
Marinduque State College
Boac, Marinduque
November 15-17 2018

Philippine Professional Standard for Teachers (PPST)

Laguna State Polytechnic University, Sta. Cruz – Main Campus
Sta. Cruz, Laguna
Sepetember 14, 2018

World Wide Link

ENGLISH SKILLS TRAINING PROGRAM
Laguna State Polytechnic University, Sta. Cruz – Main Campus
Sta. Cruz, Laguna
November 11-13, 2015

2016 STRASUC Culture and the Arts Festival

Indigenous Dance 5th placer
 Southern Luzon State University
Lucban, Quezon
October 4-6, 2016

TESDA ONLINE SEMINAR COURSE

Setting Up Computers Networks
April 26, 2020

TESDA ONLINE SEMINAR COURSE

Foundation of Massage Practice (1 to 4)
April 26, 2020

VIBAL ONLINE SEMINAR COURSE

“Online Classroom Management Reading made easy”
April 24, 2020

VIBAL ONLINE SEMINAR COURSE

“Understanding the importance of play in learning”
April 24, 2020

OUR LADY OF FATIMA Foundation Day Celebration

Sports Committee Member
March 10, 2020

LEADERSGIP DEELOPMENT PROGRAM

(RESOURCE SPEAKER)
College of Nursing Pamantasan ng Cabuyao
March 1, 2020

2019 Synergy of OLFU support services: Guidance Placement, and

discipline awareness Week Seminar “Drug Abuse Prevention”
(RESOURCE SPEAKER)
Our Lady Of Fatima University
February 18, 2020

Family details
To be completed if a position is offered at NLCS (Singapore).

Marital status single

Date of birth January 28, 1999
Nationality Filipino
Passport number P4477888B
Passport expiry date January 2030
First name of spouse/partner n/a
Surname of spouse/partner n/a
Nationality of spouse/partner n/a
Profession of spouse/partner n/a
Details of children (please list n/a
gender, and date of birth)
Is your spouse/partner also seeking employment at the school? Yes / No

Criminal records
An offer of employment from the NLCS (Singapore) operating company is conditional upon them
receiving a Disclosure from the UK’s Disclosure and Barring Service (DBS) (or equivalent) which
the School considers to be satisfactory, and/or a satisfactory criminal record search being
undertaken in your current country of residence. On their behalf, NLCS (UK) will apply for an
Enhanced Check for Regulated Activity from the DBS which includes a check of the Children’s
Barred List. NLCS (Singapore) will not employ anyone who is barred from working with children.
If you are successful in your application you will be required to complete a DBS Disclosure and/or
international equivalent. Any information disclosed will be handled in accordance with any
guidance and/or code of practice published by the DBS. A criminal record will automatically debar
you from employment at NLCS (Singapore) in line with Singaporean law.

Have you received a conviction (or a caution, reprimand or final warning from Yes / No
the police) for any criminal offence?
Have you ever been convicted of (or received a caution, reprimand or final Yes / No
warning from the police for) a drug-related offence?
Is there any relevant court action pending against you? Yes / No

References
Please supply the names and contact details of two people who may be contacted for references.
One of these must be your current or most recent employer, preferably represented by your Head-
teacher or Chair of Governors. If your current/most recent employment does/did not involve work
with children, then your second referee must be from the employer with whom you most recently
worked with children. No referee should be a relative or someone known to you solely as a friend,
and they must be someone to whom you report(ed) - not a peer colleague. References for
shortlisted candidates will be taken up prior to interview.

Referee one
Name Robert Apostol
Position History Teacher
Working relationship to you Co Teacher

Address Brgy Bubukl Sta Cruz Laguna

Contact number 09516354363
Email robertrcy45gmail.com
Referee two
Name Fredie Cadacio
Position Physics Teacher
Working relationship to you Co Teacher

Address Brgy Bulilan Sur Pila Laguna

Contact number 09219752855

Email frincevenedict@yahoo.com
 Recruitment Policy

All applicants for employment will be required to submit a letter of application and to complete an
application form containing questions about their academic and employment history and their
suitability for the role; candidates might also choose to submit a curriculum vitae in support of their
application form. Applications will not be considered unless supported by a completed application
form and cover letter. The School's Interim Safeguarding and Child Protection Policy are also
available to applicants on request.

Data Protection

All personal data will be held and processed by NLCS (Singapore) in accordance with Singapore
PDPA (July 2014). Data will be shared with and retained by NLCS International Ltd in accordance
with the General Data Protection Regulation 2018 and Data Protection Act 2018 and in accordance
with NLCS (UK)’s Data Protection Policy and guidelines. The information will be stored securely
and used only for the intended purpose stated in this form.

Declaration

 I confirm that the information I have given on this Application Form is true and correct to the
best of my knowledge.
 I confirm that I am not disqualified from work with children or subject to sanctions imposed by
a regulatory body.
 I understand that providing false information is an offence which could result in my application
being rejected or (if the false information comes to light after my appointment) summary
dismissal and may amount to a criminal offence.
 I consent to the School processing the information given on this form, including any 'sensitive'
information, as may be necessary during the recruitment and selection process.
 I consent to the NLCS (Singapore) making direct contact with the people specified as my
referees to verify the references prior to interview.

Signature

Date May 1, 2020