Membership Form

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in Education

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Your personal details

Title:

Mrs

Miss

Surname:*

Forenames:*

Previously known by any other name:*

Yes

Previous Surname:

Date of Birth:*

DD slash MM slash YYYY

Address:*

Town:*

County:

Postcode:*

Mobile Telephone:*

Work Telephone:

Email:*

Nationality:*

NI Number:*

Next of Kin:*

Relationship:

Mobile Telephone:*

Work Telephone:

Full Driving Licence:

Yes

Own Transport:

Yes

Areas looking for work:

Criminal Records & Disciplinary Action Disclosure

The existence of a criminal conviction, caution or past disciplinary action will not necessarily be a bar to the completion of your registration with justteachers. However, failure to disclose such information may lead to the rejection of your application or termination of your registration as appropriate. If you are working in an assignment with a client at the time that we are made aware of a conviction that you have not disclosed to us, we may be legally required to inform our client of that information and your assignment may be terminated. You are also required to inform us if you are the subject of any kind of investigation or prosecution by the police after this check has taken place, during the period of your registration with justteachers.

You will be classified as having substantial access to children and will be the subject to an Enhanced (DBS) with barred list check. Criminal record information provided will only be taken into account in line with the Disclosure and Barring Service (DBS) filtering rules where the offence is relevant to the post of which you are applying. If you have subscribed to the DBS Update Service your DBS certificate is portable. Upon sight of your original certificate, we can then undertake a status check.

If you have not subscribed to the DBS Update Service, justteachers will apply for a DBS check on your behalf, the current cost is £54.50 (online application). Please note there is no refund or option to withdraw/cancel once the DBS check is in process.

I consent to justteachers undertaking a status check of my DBS certificate and can confirm that I am not on the DBS barred lists or disqualified from working with children, or subject to restrictions/sanctions or prohibitions imposed by a regulatory body e.g. the Teaching Regulation Agency or known to the police (including ongoing investigations and offences which have not yet reached court) or children's social care, and have not committed offences in a country outside of the UK.

Criminal convictions

As working with children is exempted from the Rehabilitation of Offenders Act 1974, you must disclose details of previous convictions and cautions, including ‘spent’ offences. The amendments to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (2013 and 2020) provide that when applying for certain jobs and activities, certain convictions and cautions are considered ‘protected’. This means that they do not need to be disclosed to employers and, if they are disclosed, employers cannot take them into account.

Guidance about whether you should disclose a conviction or caution can be found on the Ministry of Justice website. You should also refer to the Ministry of Justice’s Guidance on the Rehabilitation of Offenders Act 1974 and the Exceptions Order 1975: www.gov.uk/government/publications/new-guidance-on-the-rehabilitation-of-offenders-act-1974

Do you have any convictions or cautions (excluding youth cautions, reprimands or warnings) that are not ‘protected’ as defined by the Ministry of Justice or is any police enquiry on-going or prosecution pending?*

YES

If YES, please provide details :

Teacher Reference Number (formerly DfES):

Additional Subjects or Key Stages you'd be happy to teach:

Have you been referred to the Teaching Regulation Authority (or its predecessors) or an overseas equivalent on misconduct grounds?*

Yes

If YES, please provide details :

Have you ever been subject to a restriction/sanction or prohibition order from a teaching regulatory body?*

Yes

If YES, please provide details :

Have concerns been raised with you in relation to your performance or competence in an education-related role?*

Yes

If YES, please provide details below :

Have you ever had a complaint made against you and / or been investigated in relation to a child safeguarding issue?*

Yes

If YES, please provide details:

Have you ever been, or are you currently, subject to disciplinary action including an investigation?*

Yes

If YES, please provide details below:

Do any circumstances exist which would prevent or restrict you from working in an educational setting including: • A prohibition order issued by the Secretary of State. • Section 128 barring direction. • EEA regulating authority sanctions. • Inclusion on a barred list (it is a criminal offence for any person to seek work in regulated activity with a group from which they are barred).• Any other restrictions?*

Yes

If YES, please provide details below:

Childcare disqualification regulations

The 2018 regulations are made under section 75 of the Childcare Act 2006 (“the 2006 act”). They set out the circumstances in which an individual will be disqualified for the purposes of section 75 of the act. The disqualification regulations will apply if you could at any point work with children under the age of eight years.

Please go to the Department for Education Disqualification under the Childcare Act 2006 – statutory guidance for schools for more information www.gov.uk/government/publications/disqualification-under-the-childcare-act-2006/disqualification-under-the-childcare-act-2006#staff-covered

Please pay particular attention to the section ‘Disqualification Criteria’. It sets out the circumstances in which individuals are disqualified from undertaking certain childcare work (relevant childcare work) under the relevant statutory provisions. As part of our safeguarding checks we are required to check whether any candidates who are seeking work that involves relevant childcare work are ‘disqualified’ from carrying out that type of work. Individuals may be disqualified because they have either been convicted of a relevant offence or are subject to a relevant order. Please review the statutory guidance which provides further details.

Staff in secondary schools only come in to scope if they provide childcare, or manage the childcare provision for those children covered by these arrangements. For example, if they host after-school childcare for children under 8.

Please tick as appropriate.*

I am seeking work in an EYFS or Primary setting and am aware that I am subject to the Childcare disqualification regulations. I declare that I have read the guidance and am not disqualified on any of the grounds set out in the statutory guidance. I will inform justteachers immediately if there are any changes in the future that may render me disqualified from working with children.

I am not seeking work in an EYFS or Primary setting; therefore, the Childcare disqualification regulations do not apply to me.

References

Please supply the names and addresses of two referees from work undertaken in the last two years, one of which must be your current or recent employer. If you have worked in education, the referee must be a member of the SLT for example Headteacher/Principal/Deputy Headteacher/Assistant Principal. If you are an Early Career Teachers (ECT) graduate, please find provide your University Mentor and one reference from a placement school. Non-education roles, an example would be your Line Manager. Please do not give the name of a relative or people writing solely in the capacity of friends as a referee. Referees will be asked about disciplinary offences relating to children, including any for which the penalty is time expired and whether you have been the subject of any child protection concerns.

Reference 1

Name*

Date from*

DD slash MM slash YYYY

Date to*

DD slash MM slash YYYY

Position/Title*

Address*

Town*

Country

Postcode*

Telephone*

Email*

Reference 2

Name*

Date from*

DD slash MM slash YYYY

Date to*

DD slash MM slash YYYY

Position/Title*

Address*

Town*

Country

Postcode*

Telephone*

Email*

By giving us contact details of references, and your signature at the bottom of this form, we will be creating letters from you to your referees, saying we have permission to ask them for references.

See content of letter we will send

Processing of Sensitive Personal Data Consent :

We require your specific, informed consent in order to process personal data relating to health and criminal convictions. I hereby give my consent to Justteachers to process the following information:

Any disability and/or health condition(s) revealed by me on the medical declaration form
Any criminal conviction(s)

Justteachers is required to process the above sensitive personal data in order to provide you with work-finding services (so that we can carry out the required vetting checks).

We may need to share this personal data with our medical advisor, client schools and also third party auditors to ensure that Justteachers is complying with all relevant laws and obligations. Your information will be securely held and processed on our computerised database.

Please tick below to give your consent to Justteachers processing your sensitive personal data in this way. The consent will last for 18 months and you have the right to withdraw your consent at any time by informing Justteachers that you wish to do so.

I agree with the statement above

Declaration:

I understand and agree to justteachers obtaining verification of the information provided as part of my registration and agree for the details contained within this application form to be shared with schools within the remit of obtaining a placement. I will inform justteachers immediately if there are any changes to the details contained within this application form.

I declare that the information set out in this application form is, to the best of my knowledge, true in all respects. I understand that by giving false information or omitting to give information, I may be removed from placement and this may result in a legal investigation. I have read and understood justteachers Limited Terms of Engagement.

I agree with the statement above

Additional information:

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