Application to serve as a member of the Admission Appeals Panel for Heckmondwike Grammar School

Personal Details: (please use block letters)

FULL NAME:                                                                         Title:

Previous Names (if applicable):                                                    

Address:

                                                                                        Postcode:

Name & address of employer

Post held

Telephone (home):                                                           (Work):                

Date of Birth:

Where did you find out about this postion?

Please answer the following questions: Please delete as applicable and add notes if you feel it necessary

1. Have you ever worked in a school:            Yes / No

NB Experience as a governor or in any other voluntary capacity does not count. If the answer is Yes please provide brief details in the space below.

2. Have you trained as a teacher:       Yes / No

3. Have you ever been employed by, or been a member of a local authority or a governing body of a school                                                       Yes / No

NB If the answer to this question is Yes please provide details as this would not necessarily disbar you from acting as a lay member of the appeals panel for this school. The question is really about your ability to act impartially in the decision making process.

4. Have you had any criminal convictions:     Yes / No

Please give detail below:

5. Please provide a brief statement in support of your application

Protection of children:

Disclosure of criminal background of those with access to children.

You have applied for a post which involves access to children.  This means that the provisions of the Rehabilitation of Offenders Act 1974 do not apply.  You must therefore, declare any pending prosecutions or convictions, cautions or bind-overs which you have had at any time.  The information will be treated as confidential.

Details: (if none write none)

Referees

Name:

Name:

Position Held:

Position Held:

Address:

Address:

Telephone:

Telephone:

Equal Opportunities Monitoring

We are committed to Equal Opportunities in Employment and as part of this policy all applicants are asked to complete the details requested below.

I would describe my ethnic origin as: (please tick)

Bangladeshi                 o            Black-African            o               Irish                  o

Chinese                      o            Black-Caribbean        o               White                o

Indian                         o            Black other (please specify)_______________

Pakistani                     o           

Asian other (please specify)_______________ Other (please specify)_______________     

Do you consider yourself to be disabled: o yes        o no

If you hold a green card please give its number:

Please complete the form in full.

NB. Canvassing will disqualify

If you are related to a governor of the school, you must declare it.

I declare that the particulars given above and in my letter of application are true, to the best of my knowledge and belief .

Signature: ____________________________________      Date: __________________Declaration