(Envelopes
should be endorsed “Confidential Application”)
POSITION APPLIED FOR:
PERSONAL DETAILS:
Title: Miss / Mrs / Mr FULL
NAME:
ADDRESS:
ETHIC
IDENTITY: DATE
OF BIRTH:
CONTACT
PHONE NUMBERS: Home ( ) Work
( )
Mobile: Fax: ( ) Email:
NEW
ZEALAND REGISTRATION NUMBER:
MOE
NUMBER (From Salary Advice):
PRESENT EMPLOYMENT:
NAME
OF PRESENT EMPLOYER:
INSTITUTION
AND ADDRESS:
CONTACT
PHONE NUMBERS Work (
) Home (
)
POSITION
HELD:
REFEREES:
1
NAME:
ADDRESS:
CONTACT PHONE
NUMBERS Work (
) Home (
)
RELATIONSHIP TO
APPLICANT: Fax
( )
EMAIL:
2
NAME:
ADDRESS:
CONTACT PHONE
NUMBERS Work (
) Home (
)
RELATIONSHIP TO
APPLICANT: Fax
( )
EMAIL:
PRIVACY ACT: (To be signed by the Applicant)
This application is
submitted on the understanding that any information given is for the use of the
employer and their authorised representatives who may have access to this
information. I agree to the Board of
Trustees (or its agents) contacting my referees for a statement of my abilities
in relation to this Application, and if necessary to seek verbal clarification
from the above referees. Consent is also given for members of the Board of
Trustees to make enquiries of my present or past employers or colleagues or any
other person who may assist in establishing my suitability for the position.
APPLICANT’S SIGNATURE: DATE:
DECLARATION:
HAVE YOU EVER BEEN CONVICTED OF AN OFFENCE AGAINST THE LAW (Apart from
summary offences?) NO YES
If YES, please provide date and details of offence/s on a separate sheet. Please note that you may be asked to provide a copy of the relevant court records available from the registrar of the court concerned.
I certify that I am registered (or provisionally registered) as a New
Zealand Teacher. I sincerely declare
that to the best of my knowledge the information given in this application and
my CV is correct.
APPLICANT’S SIGNATURE: DATE:
TERTIARY EDUCATION QUALIFICATIONS:
INSTITUTE ATTENDED YEAR QUALIFICATION ATTAINED DATE AWARDED
TEACHING (or Equivalent) SERVICE:
POSITION CLASS
LEVEL SALARY SCALE SCHOOL / INSTITUTION DATES
PERSONAL QUALITIES:
EXPERIENCE FOR THE POSITION ADVERTISED
PERSONAL STRENGTHS
LEADERSHIP STRENGTHS
RELATIONSHIP WITH PUPILS / STAFF / COMMUNITY