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Date of Birth:
Contact phone: (0
Fax number:
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Email address personal: 3 4 Registration details Registration number: Practising certificate expiry: [ ] Primary [ ] Secondary [ ] Print and post / / New Zealand Teachers Council Electoral Sector Roll (Select one) [ ] ECE
Council Election communications should be sent to me by (we recommend email): [ ] Email
Applicant to complete
Fee payment (non-refundable) Attach payment [ ] Processing fee ($120) [ ] Late fee ($50) if applicable - see Completion Guide Cheques payable to: NZ Teachers Council GST No. 81270112 Payment method: [ ] Cheque, bank cheque or money order, as attached [ ] Learning Centre payment, as attached for: [ ] Credit card, to be charged as per the following details Cardholder name:
Teachers Council must have the full fee payment before we will begin processing your application
[ [ [ [
Cardholder signature:
Applicant to complete
See the TC3 Completion Guide for detailed instructions on completing this section. From Month &Year / / / / / / / / / / / / / Continue on a separate sheet if needed. To Month &Year / / / / / / / / / / / / /
Location
Full time [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]
Part time Hours per week Hours per week Hours per week Hours per week Hours per week Hours per week Hours per week Hours per week Hours per week Hours per week Hours per week Hours per week Hours per week
See the TC3 Completion Guide for detailed instructions on completing this section.
(a) Have you spent 12 months or more in any country other than New Zealand in the last 10 years? [ ] No (go to question 8) [ ] Yes (go to 7(b)) (b) Please list the countries you have been in for 12 months or more in the last 10 years other than New Zealand.
Country
/ / /
Continue on a separate sheet if needed
/ / /
NZ clearance
You must also complete Section G on page 4 of this form.
Applicant to complete
[ ] No [ ] No [ ] No [ ] No [ ] Yes [ ] Yes [ ] Yes [ ] Yes
* In considering this criterion, the Council will distinguish between any mental or physical condition that affects an applicants ability to carry out the teaching role satisfactorily, and any disability that an applicant has that does not impact on that ability. The Council is aware of its obligation not to contravene the Human Rights Act 1993 by unlawfully discriminating against any person.
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Explanations of yes declarations [ ] Details are attached of any yes answers I gave above to Question 9. See the TC3 Completion Guide for detailed instructions Acknowledgements
Name:
my knowledge and belief, all the information in this application is entirely true and correct. I confirm that I can speak lucidly and write clearly in an official language of New Zealand. I understand that the New Zealand Teachers Council may contact any institutions or individuals named in this application, to verify the information provided. I consent to the disclosure of any relevant information contained in this form to the following organisations as required, for the purpose of processing my application and managing my registration status and so that registration dependent allowances can be confirmed: Ministry of Education (and their pay agents) New Zealand Qualifications Authority (NZQA) Education Review Office (ERO) New Zealand Immigration Service. New Zealand Police. I also consent to the New Zealand Teachers Council obtaining information from the above organisations that is relevant to my application, for the purpose of determining whether I meet the criteria for registration. I accept that the New Zealand Teachers Council may use any of the information on this form for statistical purposes, within the obligations and requirements of the Privacy Act 1993.
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Signature
Signature: Date signed:
Section F: Endorsement
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See the TC3 Completion Guide for detailed instructions on completing this section.
This teacher is of good character and fit to be a teacher (refer to Guide for definition) This teacher has had satisfactory recent teaching experience. This teachers performance has been assessed as satisfactory against the Satisfactory Teacher Dimensions. This teacher has completed satisfactory professional development.
[ [ [ [
] No ] No ] No ] No
[ [ [ [
If you have answered No to any of the above please refer to the detailed suggestions in Section F in the Completion Guide.
14 Endorser details professional leader i.e. principal for schools, centre manager /owner licensee for ECE, senior teacher for Kindergartens.
Full name: Learning centre: Registration number: Signature: Designation: Date signed:
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Second endorser details fully registered teacher (if first endorser is not currently a fully registered teacher)
I affirm the above endorsement of this application
Full name: Learning centre: Registration number: Signature: Designation: Date signed:
TC3. Application to Renew Registered Teacher's Practising Certificate Consent to Disclosure of Information by NZ Police
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Statement of consent
I, the abovenamed, hereby consent to the disclosure by the New Zealand Police of any information they may have pursuant to this application to the New Zealand Teachers Council. I understand that any record of criminal convictions I might have will automatically be concealed if I meet the eligibility criteria stipulated in Section 7 of the Criminal Records (Clean Slate) Act 2004.
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Signature
Signature: Date signed: / /
Results of Check
Inquiry processing
NZ Police to complete
Contact recommendation
Outstanding activity
Further comment
Once approved you will be notified by email, post & online via the register
You will be sent an acknowledgement letter upon receipt of the application form
Do not send:
A copy of a certified copy. Original documents (the Teachers Council does not return them.) A certified copy is a copy of the document that has been verified by an official such as: School principal / Centre Manager Solicitor Notary public Justice of the Peace Registrar, or The authority who originally issued the document.
The following verification must be marked on every page of the copy document: Certified true copy of the original document [name of official] [signature of official] [title] [address or official stamp or seal]
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Identifying details
Please complete these fields with your current details. Providing your date of birth ensures we do not mix up your records with those of another person who has the same name.
Contact details
This information gives us ways to contact you about your application, and helps us keep your records up to date. If you are only available at the contact number you provide on certain days or at certain times, please also note the day(s) and time(s). If providing an email address, please make sure it is personal and permanent. If given we will use e-mail contact firstly.
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Registration details
Give your registration number and your practising certificate expiry date, as they appear on your most recent practising certificate.
Late fee
A $50 late fee is payable if you do not have a current practising certificate when we receive your application and you are required to hold a practising certificate in your teaching position.
Learning centre
The Teachers Council will check whether you have completed enough service to maintain your full registration. (See Who is eligible for renewal on page 1 of this guide.) If we identify you have not completed enough service, your application for renewal of full registration will be changed to an application for Subject To Confirmation registration. We will send to you the necessary additional sections that have changed and need to be filled in by you.
What to request 1. Form 3019 2. Police Certificate 3. Basic, Standard or Enhanced Disclosure
2. Association of Chief Police Officers, ACRO, PO Box 481, Fareham, PO14 9FS, UK Web site: www.acpo.police.uk
OR
3. Disclosure Scotland, PO Box 250, Glasgow, G51 1YU Web site: www.disclosurescotland.co.uk Federal Bureau of Investigation, Identification Division 1000 Hollow Custer Road, Clarksburg, West Virginia 26306
For other countries, we recommend the following sources to identify the relevant authority to contact: The police in the relevant country The diplomatic office (embassy, high commission, etc.) in NZ for that country, or The following web pages:
www.migrationint.com.au/office.asp www.met.police.uk/dataprotection
If none of these sources provide the information you need, contact the Teachers Council.
NZ clearance
Everyone applying to renew a practising certificate must complete Section G. This authorises the Teachers Council to request NZ Police to make a vetting check concerning you.
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Declarations
You must tick one response box for each of these questions.
* In considering this criterion, the Council will distinguish between any mental or physical condition that affects an applicants ability to carry out the teaching role satisfactorily and any disability that an applicant has that does not impact on that ability. The Council is aware of its obligation not to contravene the Human Rights Act 1993 by unlawfully discriminating against any person. ** You should tick yes here if your employing body, the professional/registration body where you are presently registered (or where you were previously registered), the police or another government agency has begun an investigation. If you are unsure about what you need to disclose, contact the Teachers Council.
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Acknowledgements
Please complete your name as proof that you have read and accept the statements in this section. The Teachers Council will proceed with processing your application within these terms.
Signature
Make sure you sign and date the form before sending it to the Teachers Council to signify your authority and request us to proceed. We cannot process and approve the application without this.
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Applicant details
Please complete this section thoroughly, to ensure that NZ Police can process their check quickly and efficiently. If you do not have a NZ drivers licence, leave that field blank. Enter your teacher registration number as written on your practising certificate card.
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Statement of consent
In signing this statement, you authorise NZ Police to give the Teachers Council any information about you that is relevant to us determining whether you are of good character and fit to be a teacher. This includes any convictions or other concerning information the Police may hold about you.
Checklist
To avoid processing delays, use this checklist to confirm you have done everything, before you send in your application. [ ] Section A: All questions are answered. [ ] Section B: Payment attached and/or credit card details provided Section C: Teaching Experience [ ] Question 7: (If required) Certified copies of police certificates or application dates provided for all countries listed [ ] Section E: Completed and signed [ ] Question 10: Explanations attached for any yes answers [ ] Section F: Completed and signed, and (if required) countersigned [ ] Section G: Completed and signed
Professional relationships
Professional leadership