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Application Form

Application Form

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Categories:Types, Legal forms
Published by: staffncs on Mar 18, 2010
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07/14/2010

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Application for Appointment

Send applications to: The Principal Envelopes should be endorsed
Nelson Central School “Confidential Application”
70 Nile Street Curriculum Vitae should be
NELSON accompanied by a self-
addressed stamped envelope
of sufficient size to enable your
documents to be enclosed.
CV of successful applicant will
be kept on file in the school.
Position applied for: Senior Teacher Whanau Class (Year 5-6) 1 MU Permanent Position
Personal details:
Name: ____________________________________________
Address: ___________________________________________________________________
___________________________________________________________________
Contact phone number: Home ( ) _______________________
Work ( ) ________________________
Present appointment: ________________________________________________________
School: ___________________________________________________________________
Position held: ___________________________________________________________
Names, addresses and phone numbers of three referees, at least one of whom should be
your current or past senior manager or principal and can comment knowledgeably on your
performance as a teacher and educational leader.
Name: ___________________________________________________________________
Address: ___________________________________________________________________
Phone No: Home: ( ) _________________ Work: ( ) _______________________
Capacity you have known the person:____________________________________________
Name: ___________________________________________________________________
Address: ___________________________________________________________________
Phone No: Home: ( ) _________________ Work: ( ) _______________________
Capacity in which you have known the person:_____________________________________
Name: ___________________________________________________________________
Address: ___________________________________________________________________
Phone No: Home: ( ) _________________ Work: ( ) _______________________
Capacity you have known the person:____________________________________________
Education Qualifications: Date Awarded
_________________________________________ ______________
_________________________________________ ______________
_________________________________________ ______________
_________________________________________ ______________
Registration Details: (Please circle)
Full Provisional Expiry date __________
Registration number: ___________________________
Teaching Service
School Class Scale From Until
_________________________________ ____ _____ _____ ____
_________________________________ ____ _____ _____ ____
_________________________________ ____ _____ _____ ____
_________________________________ ____ _____ _____ ____
_________________________________ ____ _____ _____ ____
_________________________________ ____ _____ _____ ____
_________________________________ ____ _____ _____ ____
_________________________________ ____ _____ _____ ____
(Please continue on a separate sheet if necessary.)
Declaration:
Have you ever been convicted of an offence against the law apart from summary offences?
No Yes (If yes, please provide date and details on a separate sheet)
I give permission for any records the police may hold on me to be given to the Board of Trustees as
part of the application process.
I certify I am Registered as a New Zealand Teacher.
Do you have an existing condition that would prejudice the execution of your duties? (If yes, please
provide date and details on a separate sheet)
I declare that to the best of my knowledge the information given in this application and my C.V. is true
and correct.
Applicant’s signature: ___________________________________________ Date: _____________
(For office use only) Date application received: _________________________
Please complete for statistical purposes:
Ethnicity: __________________________ Gender: ________
Age: <30 31-40 41-50 51-60 61+ (please circle appropriate)

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