Hedingham School & Sixth Form
Achievement & Excellent
Application Form

	
Please return your completed application form to:

Personnel Assistant
Hedingham School
Yeldham Road
Sible Hedingham
Halstead
Essex
CO9 3QH

Thank you for your interest in Hedingham School and Sixth Form

The following information is necessary to ensure that full consideration can be given to all candidates. The information given will be treated as confidential.

Please ensure you complete all pages of the application form in BLANK INK or BLACK FONT. Sections that require completion are marked with a red box. If checking a selection, please mark with an X.	

	
Applicants Name:	

	

Application for appointment as:	

	

Do you need permission to work in the UK?	
Yes:	
	
No:	

	

Personal Details
Title:	

Surname:	

First Name:	

Middle Names(s):	

Previous Name(s):	

Date of Birth:	

Home Telephone Number:	

Home Email Address:	

Work Telephone Number:	

Work Email 
Address:	

Mobile Phone Number:	

Address:	

National Insurance Number:	

Please check this box if you do not wish to be contacted at work:	

	

Present Employment (if currently employed)
Employers Name and Address:	

Nature of the Business:	

Job Title:	

Date Appointed:	

Grade/Salary Spine:	

Current Salary (point):	

Allowances Received (types):	

Value of Allowances:	

Notice Period Required:	

Reason(s) for Leaving:	

	

Brief outline of your duties in your current or most recent job.

	

Previous Employment
Include all full-time and part-time positions listing the most recent job first. Please provide additional information on a separate sheet if necessary.

Employer:	
Start Date:	
End Date:	
Job Title:	
Salary/
Grade	
Reason for Leaving:	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

Breaks in Employment History
If you have had any breaks in employment since leaving school, give details of these periods and your activities during these times e.g. unemployment, raising family, voluntary work, training, long periods of sickness etc.

How many periods of sickness absence have you had over the last 2 years?	

How many days in total?	

	

Mobility 
Please complete this section if the Person Specification for the post includes these requirements.

Do you have a valid driving licence?	
	
Yes:	

No:	

Do you have access to a vehicle which you are able to use for work purposes?	
	
Yes:	

No:	

If not, are you able to travel, for work purposes, by another means of transport?	
	
Yes:	

No:	

	

Secondary School Education
Please list each subject studied on a separate line. You may add more rows if required.
School(s):	
From:	
To:	
Qualification Subject: 	
Awarding Body:	
Grade:	
Date of Qualification:	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	
Continuing Education
Please list any Universities/Colleges/Apprenticeships etc. Please add each qualification on a separate line and include the most recent first. You may add more rows if required.
Educational Establishment:	
From:	
To:	
Qualification Subject: 	
Awarding Body:	
Level/ Grade:	
Date of Qualification:	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

Professional Qualifications
Please include details of professional association memberships if appropriate.

Do you hold Qualified Teacher Status (QTS)?	
Yes:	

No:	

DfE Number:	

If yes, please complete the following:

Date of Statutory Induction Period (if qualified since August 1999):	
Start Date:	
	
Completion Date:	

General Teaching Council registration date:	

	

Other relevant training and development activities attended in the last 5 years
Please add additional rows if required or provide additional details on a separate sheet if necessary.
Course Title/Brief Description:	
Date(s):	
Organising Body:	

	

	

	

	

	

	

	

	

	

	

	

	

	
Information in support of this application
Please use the person specification as a prompt to describe the experience, skill, competencies and qualifications that make you suitable for this job. These may have been gained from your work experience, any voluntary or community work or any other organisation you may have been involved with. You should ensure that any information submitted reflects your experience relating to the competencies that are details in the Person Specification. (Please provide additional details on a separate sheet if necessary)
If you are a teacher, please provide details of any specialist teaching experience skills you possess that may be relevant to the post.

	
References
Please give the names and addresses of your two most recent employers (if applicable). If you are unable to do this, please clearly outline who your references are.

Referee 1	

Name:	

Address:	

Position:	

Telephone Number:	

Email Address:	

Check this box if you do not wish for this referee to be contacted prior to interview	

	

Referee 2	

Name:	

Address:	

Position:	

Telephone Number:	

Email Address:	

Check this box if you do not wish for this referee to be contacted prior to interview	

	

Notes:
i)	Referees will be contacted before interviews unless otherwise requested 
ii)	If either of your referees know you by another name, please give details on a separate sheet.
iii)	The school may contact other previous employers for a reference with your consent.
iv)	References will not be accepted from relatives or from people writing solely in the capacity of friends.	

Close Personal Relationships
Are you a relative or partner, or do you have a close personal relationship with any employee or Governor of this establishment?	
Yes:	

No:	

If ‘yes’, please state the name(s) of the person(s) and the type of relationship (please see the notes below):

Failure to disclose a close personal relationship as above may disqualify you. Canvassing of Governors or Senior Managers of the Academy by or on your behalf is not allowed.

Declaration
I certify that, to the best of my belief, the information I have provided is true and I understand that any false information will result, in the event of employment, in disciplinary investigation by the school, and it is likely to result in dismissal. 

Criminal Convictions
The appointment of any member of staff who may have contact with, or access to children or vulnerable adults will be subject to the receipt of a satisfactory disclosure from the Criminal Records Bureau. However, in accordance with the Rehabilitation of Offenders Act 1974, a conviction for an offence which is not relevant to the safeguarding of children may not preclude the appointment of an applicant who is otherwise qualified for the post.

Please complete the enclosed form SD2, Disclosure of Criminal Convictions. This is found at the back of this Application Form. 

Data Protection Act 2018
I hereby give my consent for personal information (including recruitment monitoring data) provided as part of this application to be held on computer (or other relevant filing systems) and to be shared with other accredited organisations or agencies in accordance with the Data Protection Act 1998.

Correspondence
Thank you for applying for this post. Your interest in working with us is very much appreciated. It is not our practice to acknowledge receipt of applications. However, we will inform you of the outcome of your application once the selection process has been completed.

Signed:	

Date:	

	

Recruitment Monitoring Information	

Post Title:	

School:	
Hedingham School & Sixth Form	

Last 
Name(s):	

First Name(s):	

Date of 
Birth:	

	

The Academy is committed to ensuring that applicants are selected on the basis of their abilities relevant
to the job. Completion of this section will help us to ensure that our policy and procedures are effective
in avoiding discrimination and promoting equal opportunities in recruitment. The information you provide
will be used for monitoring and statistical purposes only and will not be seen by the shortlisting panel. This
section will be detached from your application form prior to shortlisting.	

The categories below are in line with the 2001 census.
1. ETHNIC ORIGIN

1. White	
British	

	
Irish	

	
Other white background (please specify):

	

2. Black or Black British	
African	

	
Caribbean	

	
Other black background (please specify):

	

3. Mixed	
White and Asian	

	
White and Black African	

	
White and Black Caribbean	

	
Other Mixed background (please specify):

	

	

4. Asian or Asian British	
Bangladeshi	

	
Indian	

	
Pakistani	

	
Other Asian background (please specify):

	

5. Chinese	
Chinese	

6. Other ethnic group.	
Other ethnic group
(please specify):

	

 2. GENDER
	
Male	

	
Female	

	
Other gender
(please specify):

	

3. MARITAL STATUS
	
Married	

	
Not Married	

	

The information contained on this form will be held on a computer file.	

4. DISABILITY DISCRIMINATION ACT 1995

Before ticking the appropriate box below please first read the definition of disability.

Definition of Disability

The definition of disability, as outlined in the Disability Discrimination Act 1995 is as follows:

“A physical or mental impairment which has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities”.

To be protected under the Act:
•	an individual must have an impairment which can be physical or mental
•	it has to be substantial, that is something more than minor or trivial
•	it needs to be long term, i.e. the impairment has lasted or is likely to last in total for at least twelve months or is likely to last for the rest of the life of the person affected
and
•	it must affect their day to day activities on a regular basis.

The effect an impairment may have on day to day activities is defined in the Act as falling within the following categories:
•	mobility
•	manual dexterity
•	physical co-ordination
•	continence
•	ability to lift, carry or otherwise move everyday objects
•	speech, hearing or eyesight
•	memory or ability to concentrate, learn or understand
•	perception of the risk of physical danger

I do consider myself to have a disability as defined by the Disability Discrimination Act 1995 (as detailed above).	

	
I do not consider myself to have a disability as defined by the Disability Discrimination Act 1995 (as detailed above).	

	

Data Protection Act

I hereby give my consent for the Recruitment Monitoring Information provided on this form to be held
on computer or other relevant filing systems and to be shared with other accredited organisations or
agencies in accordance with the Data Protection Act 2018.

Signed:	

Date: