Please note that all items marked in pink are required and must be filled in.

Position applied for:		Director of Studies Residential Teacher Full-time Teacher Part-time Teacher
Preferred centre:		Select centre
Do you have accommodation here?		YES NO
Exact dates available (Most courses will require you to be available from the beginning of July):
Personal Details
Title:		Mr Mrs Miss Ms
First name:
Surname:
Date of Birth:
Nationality:
Home address:
Telephone:
Mobile:
E mail:
Current address (if different from above):
Tel:
Do you have the use of a car?		YES NO
Please give details of any illness or disability which may affect your ability to work:
Do you have a criminal record?		YES NO
If YES, please give details:
People who may be required to work with children and young people are not covered by the Rehabilitation of Offenders Act 1974, and can be required to declare all criminal convictions, spent or otherwise.
For DoS and teaching posts only (proof of qualifications will be required before appointment.)
First degree or equivalent
Date	Qualification gained	College/University
TEFL Qualifications
Date	Title of qualification	Validating Body
TEFL Experience
Date (From-To) School & location Type of lessons * Contact hours per wk Total mths/yrs * Adults / Juniors / Exams?
Non TEFL Teaching / Other Work Experience (Any gaps in CVs must be explained satisfactorily) Date (From-To) Employer Job Title / Details
SKILLS (Give details of any skills which may be relevant to student activities, e.g. sports, music, drama, etc.)
FOREIGN LANGUAGES (Please indicate either conversational or fluent)
All references will be followed up. References will include a specific enquiry as to whether there is any impediment to the prospective staff member being employed in a situation where he/she will have responsibility for the care of or substantial access to children. Appropriate Criminal Records Bureau (CRB) disclosure may be requested prior to appointment. Give the name, address, phone/fax/email and relationship to you of two referees we can contact. One should be your last employer. REFEREES MUST NOT BE FAMILY RELATIONS OR FRIENDS Referee 1 Referee 2
Where did you hear about LSC/STS?:
Have you ever?
Been convicted of any offence against a child?		YES NO
Had a child removed from your care by the order of a court?		YES NO
Had a prohibition imposed on you at anytime?		YES NO
Been disqualified from acting as a foster parent?		YES NO
Been proven negligent whilst supervising under 16's on activities/courses organised by any other organisation?		YES NO
If you have answered ‘yes’ to any of the above questions, please supply the dates and circumstances:
By submitting this application I certify that the information contained in this application is correct, and that I am not unfit to be working with juniors. Section 70(a) of the Children Act 1989 provides that a person who makes any statement in this notice or gives information which he/she knows to be false or misleading, shall be guilty of an offence and liable on summary conviction to a fine not exceeding level 5. Consent: I agree to the local authority arranging for police records to be checked for previous convictions of me, the staff member, subject to the Rehabilitation of Offenders Act 1974 and exemption orders.