The Governing Body is committed to safeguarding and promoting the welfare of children and young people and expects all staff and volunteers to share this commitment.


    Personal Details

    (We usually send all correspondence by email unless you ask us not to)

    Education and Training

    Please give details of school, colleges and universities attended from age 11, including part-time education or other courses (earlier first). GCSE / O-Level grades are not required from applicants for teaching posts. You will be expected to produce any qualifications entered in this section if selected for interview.

    From Month / Year

    To Month / Year

    School / College / University attended (including part time)

    Qualifications gained or pending, including subject or course title

    Grade(s) attained


    Job Related Training and Professional Development


    Employment History

    PREVIOUS EMPLOYMENT - Please provide a complete work history including any temporary, unpaid and voluntary work, starting with your most recent.

    From Month / Year

    To Month / Year


    Job Title

    Reason for Leaving


    Current Employer

    If you are not currently in employment, please leave this section blank.

    Date of appointment:


    Supporting Statement

    Please enclose a letter of application or supporting statement, explaining your interest in this post and why your qualifications, experience and personal qualities are relevant to this appointment.



    Give details of two people who have knowledge of you in a working / educational environment, paid or unpaid, and who can support your suitability for this appointment.

    Please read the following notes carefully before selecting your referees:

    1. The first reference should be your present or most recent employer. If you are a teacher, it should be your current Headteacher. If you are a student, give appropriate school or college referees.

    2. Where you are not currently working with children but have done so in the past, one referee must be form the employer by whom you were most recently employed in work with children.

    3. References will not be accepted from relatives of from referees writing solely in the capacity of friends.

    4. Please note that referees will be invited to submit confidential written references and may be contract by telephone. Open references / testimonials will not be accepted. Referees will be asked about disciplinary offences relating to children and whether you have been the subject of any child protection concerns, and if so, the outcome of any enquiry or disciplinary procedures.

    5. It is the normal practice for references to be obtained before any formal interview. Please note that the School reserves the right to contact any previous employer.

    May we approach your referees without further reference to you?

    Referee 1

    Referee 2






    In what capacity does this person know you?

    How long has this person known you?


    Rehabilitation of Offenders Act 1974

    All posts involving direct contact with vulnerable children are exempt form the Rehabilitation of Offenders Act 1974. (Exceptions) Order 1974.

    The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected'. These are not subject to disclosure to employers and cannot be taken into account. Guidance and criteria on the filtering of these convictions and cautions can be found on the Disclosure and Barring Service website.

    Have you ever been convicted of a criminal offence which is not protected?

    If you have answered YES, supply details of all convictions in a sealed envelope addressed to the Chair of the Recruitment panel and attach to this form. If your application is successful, this information will be checked against information form the Disclosure and Barring Service before the appointment is confirmed.

    Child Protection

    The Purcell School is committed to safeguarding and promoting the welfare of children and young people and expects all staff to share this commitment. All applicants should read the School's Child Protection Policy, which is available on our website, and are required to declare any criminal convictions or cautions, or disciplinary proceedings related to young people. All candidates selected for interview will be checked against the list of those barred from working with children prior to interview, and enhanced disclosures from the Disclosure and Barring Service will be sought on all successful applicants.

    Data Protection

    The information collected on this form will be used in compliance with the Data Protection Act 1998. The information is collected for the purpose of administering the employment and training of employees. The information may be disclosed, as appropriate, to the Governors, to Occupational Health, to the Teachers Pensions Agency, to the Department of Education, to pension, payroll and personnel providers and relevant statutory bodies. You should also note that checks may be made to verify the information provided and may also be used to prevent and / or detect fraud.

    Declaration by the Applicant

    I confirm that the above information is complete and accurate and I understand that any offer of employment is subject to:

    1. References which are satisfactory to the School

    2. A satisfactory DBS Certificate and check of the Barred list and any other checks (if applicable to the post)

    3. The entries on this form providing to be complete and accurate

    4. A satisfactory Medical Report, if appropriate

    I confirm that I have not been disqualified from working with children, cautioned or sanctions in this regard.

    Full Name:

    *Please insert an image file if possible. If not, please leave blank and shortlisted candidates will be asked to sign the form at interview.


    This section will be separate from Part 1 in receipt. Relevant contents may be verified prior to shortlisting but will not then be used for selection purposes.

    Do you have the right to work in the UK? (If NO please provide details below)

    Are you subject to any legal restrictions in respect of your employment in the UK? (If YES please provide details below)

    Are you related to or have a close personal relationship with any student, employee or governor at the School? (If YES please provide details below)

    Have you ever been dismissed from a post? (If YES please provide details separately under confidential cover)

    Do you hold a valid UK Driving Licence?

    Do you hold a D1 Driving Licence?

    As part of our equal opportunities policy, we request that you complete the following information:

    This information is for monitoring purposes only. All information will be treated as confidential and will not be used when short-listing or deciding on whether an applicant is successful or unsuccessful in obtaining employment. The information you provide will help us to ensure that our recruitment procedures are fair by allowing us to identify and eliminate potential areas of discrimination.

    Ethnic Origin

    Asian or Asian British - BangladeshiAsian or Asian British - ChineseAsian or Asian British - IndianAsian or Asian British - OtherAsian or Asian British - PakistaniBlack or Black British - AfricanBlack or Black British - CaribbeanBlack or Black British - OtherMixed Ethnic - White and AsianMixed Ethnic - White and Black AfricanMixed Ethnic - White and BlackCaribbeanMixed Ethnic Group - OtherMixed Ethnic Group - ArabWhite - IrishWhite - OtherWhite - Welsh / English / Scottish / N. IrelandPrefer not to sayOther (please specify below)


    Religious Beliefs

    BuddhistJewishChristianMuslimHinduSikhPrefer not to sayOther (please specify below)



    FemaleMalePrefer not to say


    The Equality Act (2010) defines a disabled person as someone with a 'physical or mental impairment which has a substantial and long-term adverse effect on his / her ability to carry out normal day-today activities'.

    Do you consider yourself to have a disability?
    YesNoPrefer not to say

    NoneHearing impairmentLearning difficultiesPhysical impairmentMental health conditionMental illnessMobility impairmentNeurological conditionPhysical coordination difficultiesVisual impairment (not corrected by spectacles)Speech impairmentReduced physical capacityLong standing illness or health conditionPrefer not to sayOther (please specify below)