Register - Salford Supply Desk

Personal Information

Personal Details:*

Mrs

Miss

Surname:*

Former Surname(s):

Forename(s):*

Gender:*

Male

Female

Photo:

Attach your photo here. (Optional)

Date of Birth:*

Place of Birth:

Mobile Number:*

Telephone Number Home:

Email Address:

Address line 1:*

Address line 2:

City:

Postcode:*

Teacher Agency Registration Number: (Only applicable to Qualified Teachers with QTS)

National Insurance Number

Religion

Transport:

Yes

Who should we contact in case of emergency?

Name

Relationship to candidate

Mobile

Availability & Supply Information

Are you a teacher or teaching assistant?

Teacher

Assistant

Age range you wish to teach:

Foundation

KS1

KS2

Other

If other please specify:

When are you available from?

Would you be interested in long-term work? (one term or longer):

Yes

Would you be interested in short-term work? (up to half a term) :

Yes

Would you be interested in daily placements? :

Yes

Can we call you for same day placements (from 07:00)?

Yes

	Full Day	Mornings	Afternoons
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays

Any schools or areas you don’t wish to teach at?

Further/Higher Education Qualifications (Inc. Professional Teacher Training)

College/University	Date of Qualification	Qualification Name	Subjects

Additional Interests/Skills/Abilities? E.g. music, sports, outdoor pursuits etc.

1.	2.
3.	4.

Experience & References

Experience

Please list your last three teaching appointments (NQT's - please state Teaching Practice schools; Supply teachers state schools where you have mainly worked

	Position	School Name	Year Group(s)	From	To
1.
2.
3.

Total number of years you have taught as a recognised qualified primary, secondary or special school teacher?

(you must have completed at least 26 weeks or part of a week in any one year from September to July to qualify as having taught for 1 year)

References

Please give the names, addresses & telephone numbers of referees covering the last two years. (These should be able to provide an informed and objective opinion as to your professional competence as a Supply Teacher, Nursery Nurse or Classroom Assistant.

Name:		Name:
Position:		Position:
Address:		Address:
Postcode:		Postcode:
Telephone:		Telephone:
Email Address:		Email Address:

Criminal Convictions (Please detail clearly as appropriate)

Do you have any unspent* criminal convictions?*

Yes

If Yes, state convictions and dates:

Permission to work in the uk?*

Yes

Have you lived or worked outside of the UK for a period of 12 months or more within the last 10 years?*

Yes

Data Protection Statement:

The information that you provide on this form and on any CV given will be used by Salford Supply Desk Ltd to provide you work finding services. In providing this service to you, you consent to your personal data being included on a computerised database and consent to us transferring your personal details to our clients.

We may check the information collected, with third parties or with other information held by us.

We may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in other way permitted or required by law.

Upload CV (optional):

Attach CV

Your CV has been uploaded. You can upload a different one by using the same button above.

Candidate Declaration:

I hereby confirm that the information given is true and correct. I consent to my personal data and CV being forwarded to clients on request. I consent to references being passed onto potential employers.

If, during the course of a temporary assignment, the Client wishes to employ me direct, I acknowledge that Salford Supply Desk Ltd will be entitled either to charge the client an introduction/transfer fee, or to agree an extension of the hiring period with the Client (after which I may be employed by the Client without further charge being applicable to the Client).

Signature

Name:*

Date:*