WIMBLEDON

FORM E1
COLLEGE
date
application received
references
for interview

teaching decision
informed

post of outcome

Title of the post for which you are applying: Click here to enter text.

Where did you first see this post advertised? (TES, eTeach or other):
Click here to enter text.

Safeguarding Statement:
Wimbledon College are committed to safeguarding and promoting the welfare of
children and young people and expect all staff and volunteers to share this
commitment.

This application form must be accompanied by:

1. a detailed and up-to-date curriculum vitae

2. the names and addresses of two referees who have indicated their
willingness to write references in connection with this application and who
have direct experience of your work in school – please note that references
will be taken up before candidates are called to interview

Title: First Name:

Click here to enter Click
text. here to enter text. Surname: Click here to enter text.
Address: Click here to enter text.

Home phone: Click here to enter text. Mobile: Click here to enter text.

Email: Click here to enter text.

DfE Teacher Reference Number: Click here to enter text.

Do you have Qualified Teacher Status?

QTS Certificate Number: Date of qualification as a teacher:

Click here to enter text. Click here to enter text.
If you do not have QTS please explain your position: Click here to enter text.

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A Level Qualifications
Full name and
address of School A Level subject grade date of award
Attended
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University Qualifications
Full name and
date of
address of subject(s) degree class
award
university
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to enter to enter to enter
text. text. text.
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Teaching Qualification
Full name and
date of
address of qualification
award
university
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to enter
text.

Other Qualifications
Please give details of any other qualifications or awards which may be relevant:
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(Please add additional rows where necessary)

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Employment History
Please complete in chronological order, starting with the most recent:
Post held and
Full name and
from to responsibilities including reason for
address of school
date date subjects taught and key leaving
/ employer
stages taught
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If there are any periods of time that have not been accounted for in your
application, for instance, periods spent raising a family or of extended travel,
please give details of them here with dates. The information provided in this
form must provide a complete chronology from the age of 18. Please ensure
that there are no gaps in the history of your education, employment and other
experience. Failure to provide a full account may lead to your application being
rejected.

Dates (from – to) Activity

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Staff INSET/Training record
Please give details of any courses you have attended in the past five years
course title provider date(s)
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enter text.
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enter text.
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enter text.
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enter text.
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enter text.

Please provide details of your most recent safeguarding training:

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Professional Memberships:

Please list any professional bodies of which you are a member:

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Interests and Hobbies:

Please list your interests and hobbies outside of work:

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Salary
Please give details of your current salary scale and point and any other Teaching
and Learning Responsibility (TLR) points, SEN or other pay awards:

On what salary scale are you paid? Click here to enter text.
(eg. MPS, UPS, Leadership, Inner
London)
What point are you on the scale? Click here to enter text.
Please detail any TLRs or additional Click here to enter text.
awards:
What is your current total salary? £ Click here to enter text.

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Supporting Statement
Please use the space below for your letter of application which should be no
more than two pages. The letter should reflect on your experience to date,
including CPD, and your hopes for this appointment. You should pay particular
attention to the national standards for the position for which you are applying.
Click here to enter text.

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References
Please give the details of two people who have agreed to act as referees for this
application. One referee should usually be your current head teacher and one
should be another professional (where you are not currently employed with
children, this must be your most recent school / college / employer prior to your
current employer). Both should have good knowledge of your work as a teacher.
If you are a PGCE student, one referee should be your tutor and one a head of
department from a school placement.

In accordance with Keeping Children Safe in Education (2018) we will obtain and
scrutinise references prior to interview and referees will be contacted to provide
further clarification as appropriate. All information provided by referees will also
be compared for consistency with the information you provide on this form and
you will be asked about any discrepancies.

Please advise if you do not want us to take up references at this stage and
provide reasons.

Click here to enter text.

name: Click here to enter text. name: Click here to enter text.

position: Click here to enter text. position: Click here to enter text.
Full name and address of school / Full name and address of school /
college / academy: Click here to enter text. college / academy:
Click here to enter text.

phone: Click here to enter text. phone: Click here to enter text.

email: Click here to enter text. email: Click here to enter text.
Has this person agreed to provide a Has this person agreed to provide a
reference for you in connection with reference for you in connection with
this job application? this job application?

If any of your referees knew you by another name please specify that name
alongside the details of the relevant referee.

If you or your spouse / civil partner / partner are related by marriage, blood or as
a co-habitee to any member of the Governing Body or any current employee(s)
please provide the relevant details here:

Name(s) of Governing Body Member/ Employee(s):

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Relationship(s) to you:

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Disclosure of Criminal and Child Protection
Matters and Disclosure and Barring Service
Checks
The Governing Body is obliged by law to operate a checking procedure for
employees who have access to children and young people.

Please confirm whether you have ever been the subject of any child protection
concern either in your work or personal life, or been the subject of, or involved
in, any disciplinary action in relation thereto, including any which is time expired.

If yes please provide full details:

Click here to enter text.

It is an offence to knowingly apply for, offer to do, accept, or do any

work in a regulated position if you have been disqualified from working
with children. Any offer of employment will be subject to checks being
carried out in order to ensure that you are not subject to a prohibition
order or an interim prohibition order.

In the event of a successful application an offer of employment may be made to

you which is conditional upon receipt of satisfactory Disclosure and Barring
Service Checks (“DBS Checks”) in relation to criminal and child protection
matters. Please note that a conviction will not necessarily be a bar to obtaining
employment.

By checking the box you consent to a DBS Check(s) being made:

Rehabilitation of Offenders Act 1974

If you have any convictions, cautions, reprimands or final warnings that are not
“protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions)
Order 1975 (as amended in 2013), then the details of these must be disclosed if
you are invited for interview.

If you are invited for interview, please bring The Rehabilitation of Offenders Act
1974 – Disclosure Form with you to the interview in a sealed envelope marked
“Confidential – Rehabilitation of Offenders Act 1974 – Disclosure Form”. You will
be asked to hand the form to the interviewer at the end of the interview. If you
do not have disclosable convictions, please complete the relevant section of the
Disclosure Form.

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Request for Your Consent to Process Your
Data
In compliance with the General Data Protection Regulation (GDPR), we wish to
ensure you are aware of the purpose for which we are requesting your consent
to collect and process the data we have asked you to provide on this application
form.

Important information regarding your consent

1. Wimbledon College is a Catholic education provider, we work closely with

the school’s Trustees, the Local Authority, the Department for Education,
the Catholic Education Service and Ursuline High School 6 th Form with
whom we may share information you provide on this application form if we
consider it is necessary in order to fulfil our functions.
2. The person responsible for data protection within our organisation is LBM
Schools DPO and you can contact them with any questions relating to our
handling of your data. You can contact them by emailing
schoolsDPO@merton.gov.uk.
3. We require the information we have requested on this form in order to
process your application for employment.
4. To the extent that you have shared any special categories of personal
data1 this will not be shared with any third party except as detailed in
paragraph 2 above, unless a legal obligation should arise.
5. If your application is successful, the information you have provided on this
form will become part of your personnel file which shall be retained
throughout the duration of your employment within our organisation and
afterwards in accordance with our data retention policy.
6. If you are unsuccessful, your application form and any documents you
have submitted in support of your application will be destroyed after a
period of 6 months.
7. We will keep a record of your consent as evidence that we have obtained
your consent to collect and process the data you have provided on this
application form.
8. You have the right to withdraw your consent at any time and can do so by
informing our organisation’s Data Protection Officer (see paragraph 3
above) that you wish to withdraw your consent.
9. To read about your individual rights you can refer to our fair processing
notice and data protection policies.
10.If you wish to complain about how we have collected and processed the
information you have provided on this form, you can make a complaint to
our organisation by emailing the Head Master. If you are unhappy with
how your complaint has been handled you can contact the Information
Commissioner’s Office via their website at www.ico.org.uk.

1
Article 9(1) GDPR sets out the special categories of personal data as follows: “personal data
revealing racial or ethnic origin, political opinions, religious or philosophical beliefs, or trade union
membership, and the processing of genetic data, biometric data for the purpose of uniquely
identifying a natural person, data concerning health or data concerning a natural person’s sex life
or sexual orientation….”

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Request for your consent

Please ensure that you read paragraphs 1-10 above and raise any relevant
questions before providing your consent below:

I confirm that I have read and understood paragraphs 1-10 above and that I have
been offered the opportunity to raise any relevant questions:

Please check this box if you have any objection to our collecting and processing
your personal information as described in paragraphs 1-10 above

I agree to my personal data being shared as stated in paragraphs 1 and 4 above:

Immigration, Asylum and Nationality Act

2006
The Governing Body will require you to provide evidence of your entitlement to
undertake the position applied for and/or of your ongoing entitlement to live and
work in the United Kingdom in accordance with the Immigration, Asylum and
Nationality Act 2006. More information can be found in the Notes to Applicants.

By checking the box below you confirm that you are legally entitled to work in
the United Kingdom and that you will promptly provide documentary evidence of
such entitlement when requested:

Immigration Act 2016

The ability to communicate with members of the public in accurate spoken
English is an essential requirement for the post. The requirement is applicable to
public sector workers with public-facing roles as per the statutory code of
practice relating to Part 7 of the Immigration Act 2016.

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Declaration
If you know that any of the information that you have given in this application
form is false or if you have knowingly omitted or concealed any relevant fact
about your eligibility for employment which comes to our attention then your
application form may be withdrawn from the recruitment process. Please note
that checks may be carried out in order to verify the information you have
included.

Providing false information is an offence and may result in this application being
rejected. If such a discovery is made after you have been appointed then you
may be liable to be dismissed summarily. You may also be reported to the
Teaching Regulation Agency (TRA) and/or the Police, if appropriate.

By signing below I hereby certify that all the information given by me both on
this form and in any supplementary pages and/or the supporting evidence
provided, is correct to the best of my knowledge and belief, that all the questions
relating to me have been fully answered and that I possess all the qualifications
that I claim to hold.

I acknowledge that it is my responsibility as the applicant, if invited for interview,

to disclose information to the panel which may affect my suitability and/or
eligibility to work with children and/or vulnerable adults.

date: Click here to enter text.

signed: Click here to enter text.

(The post will be subject to the terms and conditions of the Wimbledon
College model teacher contract, a copy of which will be provided to you
before interview if you are shortlisted).

Please return this form to the Head Master, Wimbledon College, Edge
Hill, London SW19 4NS.

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