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APPLICATION FOR EMERGENCY TEACHING POSITION Title:

Surname:

First Name:

Date of Birth:

Address: Postcode: Home Phone:

Mobile No.:

Email address: Country of Birth: Australian Citizen:

Yes: [ ]

VIT Registration Number and expiry:

VIT No.:

(please attach a copy to application)

Expiry:

No: [ ]

Religious Denomination:

Next of Kin Surname:

First Name:

Relationship:

Contact No.:

Tertiary Qualifications Institution Year Qualification completed

Major areas

Experience First Year Teaching?

Yes: [ ]

No: [ ]

Years of experience (excluding CRT/Emergency Teaching). List only fixed term or ongoing positions:

School

Date from

Date to

Subjects taught Year Level

Full time, Part Time, Fixed Term


Teaching Specialities/Areas Year Level

Subjects

___________

_________________________________________________________

___________

_________________________________________________________

___________

_________________________________________________________

___________

_________________________________________________________

Catholic School Accreditation Yes/No 1.

Do you have accreditation to teach in a Catholic School?

2.

Accreditation to teach Religious Education?

Date Awarded

Expiry Date

Availability Monday [ ]

Tuesday [ ]

Wednesday [ ]

Thursday [ ]

Friday [ ]

Referees 1.

2.

3.

Name:

______________________________________________________________

Position:

______________________________________________________________

School:

______________________________________________________________

Telephone:

______________________________________________________________

Name:

______________________________________________________________

Position:

______________________________________________________________

School:

______________________________________________________________

Telephone:

______________________________________________________________

Name:

______________________________________________________________

Position:

______________________________________________________________

School:

______________________________________________________________

Telephone:

______________________________________________________________


Additional Information 1. Were you ever the subject of disciplinary action?

Yes [ ]

No [ ]

If yes, please provide details: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 2. Have you ever received a written warning or been dismissed or resigned following allegations of improper or unprofessional conduct? Yes [ ] No [ ] If yes, please provide details: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 3. Our process includes asking referees whether there are any child protection concerns in your regards. Do you foresee any problems arising from this process? Yes [ ] No [ ] If yes, please provide details: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

Declaration I declare that I do not have a criminal record and I have no outstanding allegations against me in relation to student welfare or safety. I certify that the information in this application is true and correct. Signature of applicant _______________________________ Date: ___ /___/___

CHECKLIST Please ensure you have attached a copy of the following documentation to this application: •

Academic Qualifications/Transcripts

[ ]

Accreditation Certificates

[ ]

VIT Registration

[ ]

A copy of Drivers License/Passport

[ ]

A copy of your resume

[ ]

Profile for St Bernard's College

Application For Emergency Teaching Position  

Application For Emergency Teaching Position