All kinds of Birmingham

All kinds of schools All kinds of futures

TEACHING
APPLICATION FORM
Birmingham City Council is committed to safeguarding and promoting the welfare of children and
young people and expects all staff and volunteers to share this commitment.
It is committed to equal opportunities in employment and positively welcomes your application.

Successful applicants will be required to undertake an enhanced DBS check.

Please complete all sections on the form. If any section does not apply to you, enter not
applicable (n/a). Please complete in black font/ink.

It is important that you refer to the Guidance Notes before completing this form.

Electronic versions of this form are available at www.birmingham.gov.uk/jobs

This form is also available in large print, Braille or on audio tape on request.

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1. VACANCY DETAILS

Position Applied For:           

School/Establishment:      

Please enter phase/s you wish to teach

Nursery:☐ Reception:☐ KS1:☐ KS2:☐ KS3:☐ KS4:☐ Special: ☐

Main Subject (where appropriate):

Subsidiary Subject:     
Other Subject Interests, e.g. Sport, Music, Drama, Community Language. (Please give details below.)

     
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2. PERSONAL DETAILS

First Name(s):      Last Name:     

Any Previous Name/s:     
Daytime Tel:      Evening Tel:      
Mobile Tel No:      Email Address:     
Address:      Postcode:     
Do you have the right to work in the UK? Yes:☐ No:☐

Please note: Original identification documents verifying your right to work in the UK will be requested, checked and a
photocopy will be taken. If your application is successful and you commence employment, the copy of your
identification documents will be retained on file under regulations governed by the Immigration, Asylum and
Nationality Act.
We are unable to employ anyone who does not have the right to work in the UK legally. Please explain the basis upon
which you believe you will be able to live and work in the UK legally on the commencement date of your role:
     

Teacher Reference Number:     

National Insurance Number, if you have one:     

Do you have QTS, including skills test if qualified post 2004? Yes:☐ No:☐

Are you a post threshold teacher? Yes:☐No:☐ Date of successful application September:      
Are you related to or do you have a close relationship
with: A Birmingham Councillor; Birmingham School Governor;
an employee of the school to which you are applying,
or an employee of Birmingham City Council? Yes:☐ :No:☐

If yes, please provide details:

Name:      Relationship:     
Position:      Department:     
Do you wish to job share the position you are applying for? Yes:☐ No:☐

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3. RETIREMENT/DISMISSAL

Are you in receipt of a Teachers’ Pension? Yes:☐ No:☐

If yes, state date effective from and the type of pension you are receiving? i.e. Actuarially Reduced
Benefits, Age, Phased, Premature or Ill Health retirement:     
Have you ever been dismissed from a school for misconduct? Yes:☐ No:☐
If yes, date:     
Name of school and LA:     
Please attach full details of the reason for the dismissal in a sealed envelope marked ‘Private and Confidential’
and return with you application.

Have you ever been dismissed for misconduct from a Birmingham City
Council Department? Yes:☐ No:☐

If yes, date:     
Name of Department:     
Please attach full details of the reason for the dismissal in a sealed envelope marked ‘Private and Confidential’
and return with you application.

(Please be assured that providing this information will not necessarily bar you from employment)

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4. STATUTORY INDUCTION

Did you gain QTS after May 1999? If yes, where was the induction served:     
Between what dates did you serve your induction:      to      
Did you pass the induction? Yes:☐ No:☐
Do you have any period left to serve on your induction? Yes:☐ No:☐
If yes, how much longer have you got to serve:     
If not complete, please attach copies of your induction reports for the period served.
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5. EDUCATION/QUALIFICATIONS IN FURTHER/HIGHER
EDUCATION (MOST RECENT FIRST)

From To
Cert, Diploma, Grade/
Date
Degree, Higher Awarding body class
Mth Yr Mth Yr gained/expected
Degree, etc. obtained
                                              

                                               

                                               

                                               

                                               

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6. EDUCATION/QUALIFICATIONS IN SECONDARY (MOST RECENT
FIRST)

From To School
Type of Awarding Date
or Subjects Grade
Mth Yr Mth Yr exam body gained
college

                                                           

                                                           

                                                           

                                                           

                                                           

                                                           

                                                           

                                                           

                                                           

                                                           

                                                           
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7. EXPERIENCE – PREVIOUS CAREER AND OTHER (MOST RECENT
FIRST)

Please complete the following, in full chronological order, starting with your current employment and include all
employment including non-teaching. For safeguarding purposes, it is essential that all gaps in your employment history
are fully accounted for. Any employment with Teacher Supply Agencies must show the Agency as the employer and not
the school where the work was carried out. Please also include any breaks in employment history together with the reason
for the break. This information may form part of your salary assessment, so please complete the following accurately and
include all experience since the age of 18, including any part time or voluntary work. Failure to provide the correct and
accurate information may result in an incorrect salary assessment. If you have passed threshold you will need to supply a
copy of your letter of confirmation with this form.

From To
Job Title
(Also include here your Reason for chnge
Employer
Mth Yr Mth Yr current / most recent
salary)

                                         

                                         

                                         

                                         

                                         

                                         

                                         

                                         

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8. RELEVANT IN SERVICE TRAINING/PROFESSIONAL DEVELOPMENT
(MOST RECENT FIRST)

Year Organising body Course title Length of course

                       

                       
                       
                       
                       
                       
                       
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9. WRITTEN REFERENCES

Please give the name of two referees, one of whom should be your current or most recent employer. If this employment
has been within a school, this would normally be your head teacher, unless in exceptional circumstances. If you are not
currently working with children, but have previously done so, one referee must be the most recent employer who employed
you to work with children.

Head teacher applicants from maintained schools should provide the name of a senior officer designated to respond on
behalf of the maintaining authority of their current or most recent school. Head teacher applicants from academies or other
independent schools should provide the name of an appropriate person responding on behalf of the Academy Trust or
other employer. The second referee would normally be the Chair of Governors at that school.

Written references will not be accepted from relatives or people writing solely in the capacity of friends.

To comply with Keeping Children Safe in Education, we will seek and scrutinise references prior to interviews. Referees
will be contacted to provide further clarification if needed. All information provided by referees will be compared for
consistency against the information disclosed in your application form, and you will be asked about any discrepancies at
interview.
Please advise if you do not want us to take up references at this stage and provide reasons.
     

Please include an email address and you should contact your referees to let them know they may be
required to provide a reference.

Name:     
Address:      Postcode:      
Telephone Number:     
Email:     
Relationship to You:     

Name:     
Address:      Postcode:      
Telephone Number:     
Email:     
Relationship to You:     

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10. ARRANGEMENTS FOR INTERVIEW
If you have disability, are there any arrangements which we can make for you if you are called for an interview
and or/work based exercise? Yes: ☐ No: ☐

If yes, please specify, (e.g. ground floor venue, sign language, interpreter, audioloop, etc):      

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11. OTHER RELEVANT INFORMATION IN SUPPORT OF
YOUR
APPLICATION (Here, you should detail how your knowledge, skills and abilities match those set out
in the job description and person specification. No more than 3 sides of A4 paper in total)
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12. CONSENT, DISCLOSURE AND CONFIRMATION
Consent
The information collected on this form and other information which constitutes your personnel record will be used in
compliance with the Data Protection Act 2018. The information is being collected for the purpose of administering the
employment and training of employees.

The information may be disclosed, as appropriate, within the City Council, to governors of schools, to Occupational
Health and to other relevant public and statutory bodies. You should also note that because we have a duty to protect
the public funds we handle, we might need to use the information you have provided on this form to prevent and detect
fraud. We may also share this information for the same purposes with other organisations, which handle public funds.

I consent to my employer recording and processing the information detailed in this application form. I
understand that this information may be used by my employer in pursuance of its business purposes and my
consent is conditional upon my employer complying with their obligations under the Data Protection Act 2018.

Application forms of unsuccessful candidates will be destroyed after six months following an appointment to the
job.

Disclosure
The amendments to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (2013 and 2020) provides that
when applying for certain jobs and activities, certain convictions and cautions are considered ‘protected’. This means that
they do not need to be disclosed to employers, and if they are disclosed, employers cannot take them into account.

Do you have any convictions or cautions (excluding youth cautions, reprimands or warnings) that are not ‘protected’ as
defined by the Ministry of Justice?

If you do have any convictions or; before signing this section of the application form, you must check the filtering rules to
determine if you should declare them or if they are now ‘protected’ and no longer require disclosure.

Failure to disclose any previous convictions or cautions that are not protected could result in
dismissal should it be subsequently discovered.

Having a criminal conviction will not necessarily bar you from employment. Any information given, either when
returning this application form or at interview will be entirely confidential and will be considered only in relation to this
application.

Please tick ONE of the following statements:

I confirm that I have NO criminal convictions or cautions which would not be filtered in line with current guidance. I am
not barred or disqualified from working with children, or subject to a prohibition order.☐

I confirm that I DO have criminal convictions or cautions which would not be filtered in line with current guidance or are
barred or disqualified from working with children, or subject to a prohibition order. I enclose full details in a sealed
envelope marked ‘Private and Confidential’. ☐

Confirmation
I hereby certify that all the information given on this form is correct and that all questions related to me have been
accurately and fully answered, and that I am in possession of the certificates I claim to hold. I understand that should
the information given in this application be incorrect it may result in my application being rejected, or if selected for
the position, summary dismissal, and possible referral to the police.
If you are making your application in Braille or on audio tape you must declare that you have read and understood this
section and that the information you have given is true and correct at the time of completion. You may also be required
to sign a declaration to this effect at a later date.

Signature:      
Date:     
Print Name:     

13. RETURN ADDRESS

Please return to:

For School Use Only:

Please ensure that completed applications for successful candidates are returned via the new starter form on the
Schools HR Portal.