SECTION A – PERSONAL INFORMATION

NAME: _________________________________

TITLE: Mr/Mrs/Miss/Ms/Other______________

ADDRESS: ______________________________

POST CODE:_____________________________

TEL. NO: ________________________________

MOBILE NO:_____________________________

E-MAIL ADDRESS:________________________

NATIONALITY:_____________________DOB:__

PRESENT OCCUPATION: ___________________

DO YOU HAVE BRITISH CITIZENSHIP : YES/NO
(If No, please complete Section D)

SECTION C – OTHER INFORMATION

HAVE YOU FAILED/WITHDRAWN FROM A TEACHER TRAINING COURSE IN THE PAST?____________________YES/NO
(If Yes please provide details (use a separate sheet of paper if necessary)

DO YOU HAVE ANY EXPERIENCE OF TEACHING YES/NO
(If Yes please provide details (use a separate sheet of paper if necessary)

HEALTH
Please state the number of days absent from work due to sickness in the last
two years and indicate reasons.

Please note: You may be subject to an occupational health check as part of
Havering’s recruitment procedure).

DISABILITY
Do you consider yourself to have a disability? If yes, specify.



If you have a disability and are invited for an interview, please
give details of any special arrangements that you require.

SECTION D – RESIDENTIAL STATUS

PERMANENT LEAVE TO REMAIN IN UK __________________
Expiry Date______________________

LIMITED LEAVE TO REMAIN IN UK______________
Expiry Date _____________________

STUDENT VISA______________________________
Expiry Date_____________________

OTHER CIRCUMSTANCES (Please specify)

DO YOU REQUIRE A WORK PERMIT_____________YES/NO