Application Form
Teacher
Durston House is committed to safeguarding and promoting the welfare of children and young people and expects
all staff and volunteers to share this commitment.
Please read the school’s Safer Recruitment, Selection and Vetting Policy and our Child Protection & Safeguarding
Policy on our website prior to completing the application form.
Position applied for:
Personal Information
Title
Forename (s)
Surname
Former Name (if applicable)
Preferred Name:
National Insurance Number:
Email Address:
Home Telephone:
Mobile Telephone:
Address:
Postcode:
How long have you lived at this address?
If less than 5 years please provide all previous addresses for past 5 years.
Previous address:
Previous address:
Postcode:
Postcode:
Length of time at address:
Length of time at address:
12-14 Castlebar Road, London W5 2DR Telephone 020 8991 6530
info@durstonhouse.org www.durstonhouse.org
@durstonhouse
Registered in England No. 1947995 Registered Office as above Charity No. 294670
1
General Information
Do you have Qualified Teacher Status?
Yes
No
UK Teacher Reference No.
Please provide full details of membership of any
professional bodies
Are you legally eligible for employment in the UK?
Do you require a work permit to work in the UK?
Yes
Yes
No
No
If you know, or are related to, any current employee, pupil
or governor, state the name and nature of the relationship:
Academic Qualifications
Please provide full details of all positions held and of all training/further education, employment, self-employment and
unpaid work since leaving secondary education.
Please provide explanations for any periods not in further education or training.
Secondary Education
Dates:
From
To
Name of School
& Address
Subjects Studied - GCSE and
A Level
Grade/
Award
Further Education
Dates:
From
To
Name of University/College
& Address
Course and Subjects Studied
Grade/
Award
2
Professional Development (attended during the last 3 years)
Dates:
From
To
Name of Course
(and award if gained)
Provider
Full-Time/Part-
Time or Seconded
Current and Most Recent Employment
Please supply a full history in chronological order (with start and end dates) of all employment, self-employment and any
periods of unemployment since leaving secondary education.
Please provide explanations for any periods not in employment, self-employment or further education/training and in
each case any reasons for leaving employment.
Current Employment
Name of Employer
Address
Title of Post
Employment Dates – To and From
Salary (basic) if appropriate (Please indicate spine point)
Notice Period
Additions (Please indicate responsibility points, London Allowance etc.)
Reason for Leaving:
Previous Employment
Name of Employer
(including full address)
Dates: To and From
Position Held (including
subject taught and at which
level)
Reason for
Leaving
Please continue onto the next page if needed
3
Previous Employment
Continued
Name of Employer
(including full address)
Dates: To and From
Position Held (including
subject taught and at which
level)
Reason for
Leaving
Interests & Hobbies
Please give details on your interests, hobbies or skills – in particular any which could be of benefit to the School.
Miscellaneous
Any further information (include any details you may consider relevant or of interest to this application)
4
Statement
Please set out in detail below a statement in support of your application, which addresses the criteria in the person
specification for this post.
5
References
Please provide at least two professional referees. One referee should be your current or most recent employer.
We will seek references for all longlisted candidates, and may approach previous employers for information to verify
particular experience or qualifications, before interview.
Referee 1
Referee 2
How is this person known to you?
How is this person known to you?
Name
Address
Position
Tel No.
Email
Data Protection
Name
Address
Position
Tel No.
Email
The information that you provide on this form will be used to process your application for employment. The personal
information that you provide will be stored and used in a confidential manner to help with our recruitment process. More
details as to how we will process your data is set out in the School’s Privacy Policy which can be found on our website
www.durstonhouse.org.
If you succeed in your application and take up employment with the School, the information will be used in the adminis-
tration of your employment.
We may check the information provided by you on this form with third parties. We reserve the right to carry out an
online search for shortlisted candidates.
Declaration
As the job for which you are applying involves substantial opportunity for access to children, it is important that you
pro-vide us with accurate answers. You should be aware that the School will institute its own checks on successful
applicants with the Disclosure and Barring Service (DBS), and, where appropriate, a check of the Barred List maintained
by the DBS, and any offer of appointment will be made conditional on obtaining such satisfactory checks.
I have not been disqualified from working with children, I am not prohibited from working with children, and I am not
subject to any sanctions imposed by a regulatory body (e.g. the General Teaching Council for England, or the Teaching
Regulation Agency).
I declare that the information I have given in this Application Form is accurate and true. I understand that providing
mis-leading or false information will disqualify me from appointment or if appointed, may result in my dismissal.
Signature
Date
Please return your completed application form to recruitment@durstonhouse.org
6
