teaching jobs

How did you hear about STC Consortium Ltd?First Names*Surname*Title*Gender* Male FemaleAddress* Postcode*Nationality*Country of Birth*Date of Birth*Age*Marital Status*Previous Surname if applicable*
Phone*E-mailAlternative Phone Number
DCSF NumberNI Number*

I am available for supply work on the following days:

	Monday	Tuesday	Wednesday	Thursday	Friday
All Day
am only
pm only
none

I would be happy to be contacted in the morning for emergency supply cover* Yes NoI would be interested in long term assignments* Yes NoI would be interested in a permanent position* Yes NoDo you have any criminal convictions other than those which ar spent pursual to the Rehabilitation Of Offenders Act 1974?* Yes NoAt this time is there any case pending against you or suspension from any previous emplyer for any offence?* Yes NoDo you hold a Criminal Records Bureau enhanced disclosure?* Yes NoAre you registered with the General Teaching Council?* Yes NoDo you have experience/qualificaitons of special educational needs?* Yes NoDo you have experience/qualifications of emotional behaviour difficulties?* Yes NoDo you have experience/qualifications of moderate learning difficulties?* Yes NoDo you have transport for work?* Yes NoAre you a Newly Qualified Teacher?* Yes NoIf no, total number of years you have taught as a recognised qualified teacher* years

Year Group / Key Stage Teaching Abilities* (minimum of one selection)

Year Group	Speciality Year Groups	Experienced	Subject Specialism	General Cover
Nursery
Reception
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Key Stage 2 (Middle)
Key Stage 3 (Middle)
Key Stage 3
Key Stage 4
Post 16 NVQ
A Level Grade

Key Stages - Middle/Comprehensive (Applicable only)Additional subject(s) you are prepared to teach

Further/Higher Education (including Professional Teacher Training)

College/University	Date of qualification	Qualification

Additional Skills/Abilities/Areas of Responsibility e.g. SEN, EBD, Music, Arts, Sports, Outdoor Pursuits

12345678

Additional Qualifications e.g. SEN, EBD, TESOL, CCRS (Formerly Catholic Teacher's Certificate), Sign Language

1234

Which LEAs would you prefer to work in?

12345678

References* Please provide two recent referees, one of whom should be your present head teacher/employer. If you are not currently teaching in schools or are unemployed, please state your previous head teacher/employer

NamePositionAddress PostcodeTelFax

NamePositionAddress PostcodeTelFax

Emergency Contact Telephone Number
Relationship to Emergency Contact

Confidential Declaration of Health

Following the recommendations of DCSF Circular 13/93 we are required to satisfy ourselves that you have the phyical and mental fitness to work with children in school or other educational establishments. Please complete the following medical history questions

Have you ever, to the best of your knowledge, suffered from any of the following?

Blackouts, Epilepsy, Fits or Faints Yes NoHeart disease or disorder Yes NoHigh blood pressure Yes NoTuberculosis, Bronchitis, Asthma Yes NoNervous or mental disorder (Nerves) Yes NoSkin disease or dermatitis Yes NoDiabetes or sugar trouble Yes NoEye disease or disorder Yes No

Are you a registered disabled person? Yes NoHave you ever changed your job for health reasons? Yes NoAre you awaiting any surgical operation or hospital appointment? Yes NoDo you suffer from hearing difficulties in either ear? Yes NoHave you ever been referred to a psychiatrist? Yes NoHave you any alcohol or drug related problem or illness? Yes NoAre you carrying Hepatitis B or the AIDS virus? Yes NoHave you any health problems that have not already been mentioned? Yes No

Please indicate additional information which you consider relevant to your application

I have read and accept the Terms & Conditions?*

* indicates a required field

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