Teachers : Vacanies : Register

Please click here for a PDF of the Teachers Vacancies Form or complete the form below:

Personal Information
Title:
First Name(s):
Surname:
Address:
Post Code:
Home Number:
Mobile:
Maiden Name
(if applicable):
Date of Birth:
 
National Insurance Number:
DFES No:
GTC Registered:
CRB No:
Email:
Do you consider yourself disabled under the disability discrimination act (DDA)?
 
If yes please provide details below:
 
 

Type of Work Required
  Long Term
Short Term
Daily
Permanent
Nursery
Primary
Secondary
SEN
Location: Hull
East Riding
York
N.Yorkshire
N.E Yorkshire
N.Lincolnshire
Lincolnshire
Maximum Travel Time:
 
Teaching Subjects:
Days Available: Monday
Tuesday
Wednesday
Thursday
Friday
Comments:
 

Education
Education 1:
Education 2:
 
Education 3:
Education 4:
 

Employment History (covering the last 5 years
1: School / Company Name:
1: Dates Employed:
1: Position & Responsibilities
2: School / Company Name:
2: Dates Employed:
2: Position & Responsibilities
 
3: School / Company Name:
3: Dates Employed:
3: Position & Responsibilities
4: School / Company Name:
4: Dates Employed:
4: Position & Responsibilities
 

Teaching Experience
Please provide a brief summary of your teaching experience to date:
 

Medical History
1: Any type of allergy?   Yes    NO  
2: Any type of skin complaint?   Yes    NO  
3: Blackout, Migraine, Epilepsy, Fainting?   Yes    NO  
4: Bowel Disorder (e.g. Typhoid, Cholera, Chronic Diarrhoea and Dysentery)?   Yes    NO  
5: Heart Complaint?   Yes    NO  
6: Have you or any of your relatives had TB or any infectious disease?   Yes    NO  
7: Mental or Nervous Breakdown?   Yes    NO  
8: Disorders of Eyes / Ears / Nose?   Yes    NO  
9: Jaundice or Anaemia?   Yes    NO  
10: Diabetes or a Glandular complaint?   Yes    NO  
11: Have you ever been informed that you are a carrier of Salmonella?   Yes    NO  
12: Are you receiving Medical Attention at present?   Yes    NO  
13: Have you ever been dismissed or refused employment on health grounds?   Yes    NO  
14: Do you suffer any illness or impediment that could prevent you carrying out your duties as a teacher?   Yes    NO  
If yes to any of the above, please give brief details:
In case of an emergency please provide us with details of your next of kin:
Next of Kin:
Contact No. (Day):
Address:
Postcode:
 
 
Relationship:
Contact No. (Evening):

Additional Information
Do you have any spent / unspent or pending criminal convictions?   Yes    NO  
If yes, please list your criminal convictions and their dates below. The information you give will be treated in confidence and only taken into account where, in the reasonable opinion of Leap Education, the offence is relevant to the post for which you are applying. Failure to declare a conviction may require us to exclude you from our register or terminate an assignment if the offence is not declared but later comes to light.
Details:
 

References
Please provide 3 references ensuring at least 2 are either employers or teaching.

Types of References: A: Academic E: Employment P: Personal T: Teaching
Reference 1:
Ref Type:
Dates of Employment:
Name & Position:
Telephone No:
Fax No:
Email:
 
Address:
Postcode:
 
Reference 2:
Ref Type:
Dates of Employment:
Name & Position:
Telephone No:
Fax No:
Email:
 
Address:
Postcode:
 
Reference 3:
Ref Type:
Dates of Employment:
Name & Position:
Telephone No:
Fax No:
Email:
 
Address:
Postcode: