APPLICATION FORM

Please use a black font or black ink as appropriate.

You are requested to complete as much of this form as possible, and to provide full contact
details [including email addresses] of two referees.
Please note that in order to be considered for a position at the school, you must complete
this application form. A CV will not be accepted in place of a completed application form.

Position applied for:

Personal Details

Preferred title
Dr/Mr/Mrs/Miss/Ms
First Name(s)

Surname Former names

*if applicable
Teachers Registration National Insurance
Number (TRN) Number
*If applicable
Current Address

Contact Number(s) Home Mobile

Email Address

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 Education and Academic Qualifications

Name of Subject Date of Qualification, award

School/College/University/Other body and Grades/Honours
and date of attendance

Please provide details of any other courses or training relevant to this application and
indicate date the awards was earned.

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 Employment

Name of current
employer/most
recent employer
Employer’s
address

Current/most
recent job title
Reason for leaving

Date Appointed Date employment

ended (if applicable)
Notice required Salary

Previous employment

Please ensure a full employment history is detailed (since leaving school, including
education, employment and voluntary work) including reasons for any gaps in
employment.

Period of Service Title of post and Reason for Leaving Salary

name/address of
From To employer

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Please account for any gaps in your employment history with details and dates.

Additional Information
Please provide any further information in support of your application including personal
qualities and experience relevant to the position.

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 References

Please supply the names and contact details of two referees. One reference must be
from your current or most recent employer. Neither referee should be a relative or
friend.

If Mount Kelly receive a factual reference i.e. one which contains limited information
additional references may be sought.

Name Name

Position Position

Organisation Organisation name

name and and address
address

Telephone Telephone Number

Number
Email Email
Address Address

May we approach this referee without May we approach this referee without
further reference to you? further reference to you?

YES NO YES NO
In what capacity do you know the above? In what capacity do you know the above?
e.g. line manager, Head Teacher, Head of e.g. line manager, Head Teacher, Head of
Department Department

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 Declaration

Mount Kelly is committed to safeguarding and promoting the welfare of children and
young people and expects all staff and volunteers to share this commitment. The
successful applicant will be required to undertake a criminal record check via the
Disclosure and Barring Service (DBS).

Employment with the School is conditional upon the School being satisfied with the result
of the Enhanced DBS Disclosure. Any information disclosed will be handled in accordance
with any guidance and / or code of practice published by the DBS.

Mount Kelly follow guidance on safer recruitment practice to ensure that staff are
recruited safely and fairly, and that children’s safety is being considered at every stage of
the process. Candidates should expect the School to seek to clarify any anomalies or
discrepancies in the information provided by them or arising from their references. The
interview process will explore candidates’ suitability for working with children and their
previous experience in such roles.

Please state whether you have enhanced clearance YES NO

by the Disclosure and Barring Service
If applicable please give details below including date of issue, certificate reference
number, and sponsor.

Is the certificate registered with the DBS Update YES NO

Service?
The amendments to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975
(2013 and 2020) provides that when applying for certain jobs and activities, certain
convictions and cautions are considered ‘protected’. This means that they do not need to
be disclosed to employers, and if they are disclosed, employers cannot take them into
account. Guidance about whether a conviction or caution should be disclosed can be
found on the Ministry of Justice website.

It is an offence to apply for the role if the applicant is barred from engaging in regulated
activity relevant to children.

Only applicants who have been shortlisted will be asked for a self-declaration of their
criminal record or information that would make them unsuitable for the position.

Are you related to or have a close relationship to a YES NO

member of the school’s staff or Governor of the
school?

If yes, please supply details.

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 I understand that failure to complete the form fully YES NO
and accurately could result in an incorrect
assessment of salary, and / or exclusion from short
listing, or may, in the event of employment, result
in disciplinary action or dismissal.
I consent to the School processing the information YES NO
given on this form, including any 'sensitive'
information, as may be necessary during the
recruitment and selection process.

I hereby certify that the statements on this form are correct and that no material
information is omitted.

Signed________________________________________________Date_________________

Where this form is submitted electronically and without signature, electronic receipt of this
form by the School will be deemed equivalent to submission of a signed version and will
constitute confirmation of the declaration.
As part of the due diligence checks online searches will be completed on shortlisted
candidates.
Candidates selected for interview will be asked to provide original documents of
identification, entitlement to live and work in the UK and relevant qualifications.
Covering letters and CV’s may be submitted with a completed application form but
incomplete and late applications are not usually considered.

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