Application Form
Application Form
Position applied for: Senior Teacher Whanau Class (Year 5-6) 1 MU Permanent Position
Personal details:
Name: ____________________________________________
Address: ___________________________________________________________________
___________________________________________________________________
Work ( ) ________________________
School: ___________________________________________________________________
Names, addresses and phone numbers of three referees, at least one of whom should be
your current or past senior manager or principal and can comment knowledgeably on your
performance as a teacher and educational leader.
Name: ___________________________________________________________________
Address: ___________________________________________________________________
Name: ___________________________________________________________________
Address: ___________________________________________________________________
Name: ___________________________________________________________________
Address: ___________________________________________________________________
_________________________________________ ______________
_________________________________________ ______________
_________________________________________ ______________
_________________________________________ ______________
Teaching Service
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 on a separate sheet)
I give permission for any records the police may hold on me to be given to the Board of Trustees as
part of the application process.
Do you have an existing condition that would prejudice the execution of your duties? (If yes, please
provide date and details on a separate sheet)
I declare that to the best of my knowledge the information given in this application and my C.V. is true
and correct.