Position Applied For
Full Name
Date of Birth
Teacher Registration Number
Ministry of Education Number
Number of Years Teaching
Address
Home Phone
Work Phone
Mobile Phone
Email Address
Present Position
Present Employer
Are you a NZ Citizen? Yes No
If no, do you have NZ Residency? Yes No
If no, do you have a work permit? Yes No
1. Education and Qualifications
Start Date January February March April May June July August September October November December
Finish Date January February March April May June July August September October November December
School Attended
Other Schools Attended
Start Date January February March April May June July August September October November December
Finish Date January February March April May June July August September October November December
Institution
Qualification
Start Date January February March April May June July August September October November December
Finish Date January February March April May June July August September October November December
Institution
Qualification
Start Date January February March April May June July August September October November December
Finish Date January February March April May June July August September October November December
Institution
Qualification
Other Qualifications, Certificates or Licenses (give details)
2. Employment History (from most recent employer)
School
Position Held
From January February March April May June July August September October November December
To January February March April May June July August September October November December
Subjects Taught
Co-Curricular Involement
Reason(s) for Leaving
School
Position Held
From January February March April May June July August September October November December
To January February March April May June July August September October November December
Subjects Taught
Co-Curricular Involvement
Reason(s) for leaving
School
Position Held
From January February March April May June July August September October November December
To January February March April May June July August September October November December
Subjects Taught
Co-Curricular Involvement
reason(s) for leaving
3. Referees (from most recent)
1. Referees Name
Referees Position & occupation
Referees Address
Home Phone
Work Phone
Mobile Phone
Referees Email Address
2. Referees Name
Referees Position & Occupation
Referees Address
Home Phone
Work phone
Mobile phone
Referees email address
3. Referees Name
referees position & occupation
Referees Address
Home Phone
Work Phone
Mobile Phone
Referees email address
4. Medical
Te Puke High School is an Equal Employment Opportunities (EEO) employer. In addition, the Health and Safety in Employment Act requires the employer to identify hazards and to provide a safe work place. A person's physical state may pose a hazard for themselves of other, hence the need to ask the following questions.
Are you currently receiving medical treatment and/or medication? Yes No
If Yes, please provide details
Are you allergic to, or have any sensitivity to any substances and chemicals? Yes No
If Yes, please provide details
Do you have a serious illness or injury that may effect you in the role you are applying for? Yes No
If Yes, please provide details
Do you have any other known condition that may effect you in the role you are applying for? Yes No
If Yes, please provide details
Have you been convicted of any offence against the law (apart from minor traffic convictions)
OR are you awaiting the hearing of charges in a civil or criminal court of law
OR know any reason why you should not be employed to work in the school environment?
Yes No
If yes, please provide date(s) and details of the offence, with any comments you wish to make. Please note that failure to provide correct and true details of any conviction or other reasons will make you liable to dismissal from employment at Te Puke High School, should you be the successful applicant.
6. Declaration
Do you consent to personnel directly involved in the selection process seeking information about you from representatives of your previous employers and referees and authorise the information sought be released?
Yes No
I declare that the information given in this application, is to the best of my knowledge, correct and I understand that if any false or deliberately misleading information is given, or any material fact suppressed, I will not be accepted, or if I am employed I will be liable to dismissal from employment at Te Puke High School.
Yes No
Date
